NRC Research: Diabetes Among Indians

Too many American Indians suffer with Diabetes — Elders, adults, and youth alike. NRC Program Partners often tell our staff that as many as 30% to 35% of the people in their community have Diabetes. Some say the prevalence is as high as 50 to 55% or 1 in 2 people, compared to the US norm of 1 in 5.

Research by the Center for Disease Control (CDC) supports Program Partner estimates. It shows that the prevalence of Diabetes among American Indians is in fact higher than for other groups, and that overall, American Indians are 2 to 3 times more likely to have Diabetes than non-Hispanic whites.

CDC’s latest estimate is that 15.1% of the entire American Indian population aged 20 and older has Diabetes. That would be about 118,000 American Indians. And the prevalence of Diabetes is different in different Indian communities. Among American Indians in the southern US, about 26.7% have Diabetes, and the highest prevalence is in southern Arizona at 27.6% of American Indians. Arizona is where our Navajo, Hopi, and Pueblo friends live.

So what we have is American Indians with smaller populations, higher incidences of Diabetes than any other ethnic group in the US, and more at risk than everyone else in the US. Diabetes dwells among us, but it’s more pressing for these First Americans. The number with pre-diabetes is also growing.

A Fact of Life
Diabetes maims, robs, and kills the body and takes away the spirit of living. No one can feel too spirited when they’re too weak to stand up or even talk. Diabetes can dog your every step. This is a fact of life. Of course, Type II diabetes can be controlled with proper diet, weight management, and exercise, and sometimes insulin or other medications.

Nonetheless, in 2002, Diabetes was the 6th leading cause of death in the US — taking 73,249 lives that we know of. The CDC suspects that even more deaths occurred that did not list Diabetes as a factor. But when you consider all the ways that Diabetes can affect one’s health, their suspicion makes sense.

COMPLICATIONS ARISING FROM DIABETES: (In the US and Puerto Rico)

Heart Disease and Stroke — This accounts for 65% of deaths in people with Diabetes. Heart disease death rates are 2 to 4 times higher for adults with Diabetes. Their risk of stroke is also 2 to 4 times higher than for adults without Diabetes. High Blood Pressure or Hypertension — Either hypertension or high blood pressure of 130 over 80+ is found in 73% of adults with Diabetes. Blindness — Diabetes is the leading cause of blindness in adults over 20. Between 12,000 and 24,000 new cases of Retinopathy lead to blindness every year. Kidney Disease — Diabetes is the leading cause of kidney failure. It accounted for 44% of all new cases in 2002. In the US and Puerto Rico, some 44,000 people with Diabetes began treatment for end-stage kidney disease (aka renal disease) that year. And 153,700 people were living on chronic dialysis or with a kidney transplant. Nervous System Damage — About 60 to 70% of people with Diabetes have mild to severe forms of nervous system damage (e.g., impaired sensation or pain in the feet or hands, slowed digestion of food in the stomach, carpal tunnel syndrome, and other nerve problems). About 30% of people with Diabetes over 40 have impaired sensation in at least one foot. (This contributes to falls, hip fractures, and other accidents.) Loss of Limbs — The most severe nerve disease can result in amputation of the lower extremities. Over 60% of lower-limb amputations that are nontrauma-related occur in people with Diabetes. About 82,000 people lost a limb to Diabetes in 2002. Dental Disease — Periodontal (gum) disease is more common in people with Diabetes and twice as common for young adults with Diabetes, compared to young adults without it. About one-third of people with Diabetes have severe gum disease and their teeth detach from their gums. Pregnancy — Major birth defects result in 5 to 10% of pregnancies where Diabetes is poorly controlled before conception and during the first trimester. Spontaneous abortion results in 15 to 20% of such pregnancies. In the second and third trimester, excessively large babies can result and pose a risk to mother and child. Chemical Imbalances — Diabetes that is uncontrolled can cause acute, life-threatening events such as bio-chemical imbalances and even coma. General Susceptibility to other illnesses is also a factor for people with Diabetes. Once other illnesses are acquired, the prognosis is often worse and people are more likely to die from pneumonia or flu, for instance, than are people without Diabetes.

[Source: CDC at www.cdc.gov/diabetes/pubs/estimates05.htm, accessed 7.27.07.]

The known death rate linked to diabetes among American Indians is 430% higher than the general US population. [Source: Diabetes in American Indians and Alaska Natives Fact Sheet, National Diabetes Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Diseases, NIH Publication No. 99-4551, April 1999, as published at www.doh.wa.gov/ndep/campaign/DIABET~2.DOC]

The Navajo Elders visited by NRC staff and Program Partners in the Thoreau community of New Mexico had many of the above symptoms. Four Elders (Nancy, Rosita, Betty, and Joan) had multiple symptoms from the chart. We took these Elders generous fresh boxes of white meats (turkey and chicken), fresh produce, fresh fruit, and whole-grain products in the hopes that they would like some of these foods and add them to their diets.

We know, however, that these Elders are living on $400 to $650 a month. Obtaining the fresh meats and fresh produce needed to control diabetes, with limited income and access, is a challenge. So is getting the amount of exercise needed to manage their weight; often they are too weak to do anything but sit in a chair. Think about this and you will understand the dilemma of all who dwell with Diabetes, especially our American Indian friends to the North and South who need your help.

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