National Institute of Diabetes and Digestive and Kidney Diseases

23 Jan

Diabetes-related kidney disease drops among Native American

Paul Rooks (L), 49, his wife Ester (C) and son Damon chat in their home while waiting to depart for the clinic on the Pine Ridge Indian Reservation in South Dakota. It's a monotonous routine that Mr. Rooks endures three times a week, and one that is becoming necessary for an increasing number of Native Americans across the rural United States. A ongoing report by the Strong Heart Study, funded by the U.S. National Institutes of Health, says that more than 50 percent of Native Americans over the age of 45 are diabetic. A member of the Oglala Lakota tribe, Mr. Rooks has kidney failure brought on by diabetes. According to the American Diabetes Association, Native American diabetics are six times more likely to suffer renal failure than others who have the disease. Photo taken June 25, 2001. AC - RTRL26Q

The Native American populations, heavily afflicted by diabetes during the last several decades, have been a dramatic decrease in kidney failure often related to the disease, the Center for Disease Control and Prevention disclosed earlier this month.

The CDC announced that between 1996 and 2013 there was 54% reduction in the number of diabetes-related kidney failure, called end-stage renal disease.

The data in the CDC report stated that Type-2 Diabetes still causes 2 out of 3 kidney failures in Native Americans.

The Native American communities have the highest proportion of diabetes among all U.S. populations. About 16% of adult Native Americans people has diabetes, compared to the national average among adults is 9.3% or 29 million people, according to the statistics from the CDC.

According to the Indian Health Service, a federal agency charged with improving the health of the estimated 2.2 million Native Americans and Alaska Natives, an aggressive campaign to educate and treat diabetes, bolstered by support of $150 million in annual federal funding through the Special Diabetes Program for Indians (SDPI), played a large part in the reductions.

“This decline is especially remarkable given the well-documented health and socioeconomic disparities in the Native Americans and Alaska Native population, including poverty, limited healthcare resources, and disproportionate burden of many health problems,” the CDC report stated.

“We very rural… Our patients don’t have access, like the rest of the country. It’s getting out of those people, identifying them and getting the resources” – Jared Eagle, director of the Ft. Berthold Diabetes Program.

The CDC told the NewsHour that in 1996, 673 Native Americans started treatment for kidney failure and in 2013 that number rose to 705. However, while the number of new incidents increased, the overall Native American population also went up considerably resulting in a decrease in the overall percentage of cases.

Dr. Ann Bullock, director of Division of Diabetes Treatment and Prevention for IHS, said the program targets both rural and urban populations with efforts beginning in the 1980s.

Since 1997, the program has provided grants for diabetes prevention and treatment to more than 400 Indian Health Service (IHS) locations, tribal committees, and urban centers – allowing more people to have access to the diabetes clinical teams, to adults weight management programs, to medicines that protect kidneys and to strategies that catch at-risk patients before diabetes begins.

In a 2014 report to Congress, IHS stated diabetes prevention and healthy living programs helped decreases in kidney disease in Native American communities, where high rates of obesity are common and access to healthy food options and medical facilities are often scant.

Nancy Haugen, a diabetic consultant for the IHS, said her outfit covers approximately 130,000 Native American and 17 tribes in North Dakota, South Dakota, Iowa, and Nebraska. Many of the on-the-ground practices used to decrease the number of kidney failures related to diabetes was also used in those states.

She said many people live far away from medical care, don’t have sick leave or access to food or gas money.

“You’re not just treating the people who darken your door,” Haugen said. “Public health workers get out and check on some of these people.”

She said that early intervention is the key to reducing kidney-related disease, one of the factors that created a heft of diabetes in the Native communities. Such tactics include screening activities, health fairs, and fitness challenges at schools.

Depending on the location and the involvement, thing like community gardens, canning and preserving classes, programs on traditional foods and the creation of health centers can also be a part of the process.

“Some of the programs started out in the beginning in 2008,” Haugen said. “And now have 400 people showing up.”

The Ft. Berthold Diabetes Program in North Dakota holds regular fitness classes as part of a Indian Health Service program to address high numbers of diabetes and kidney failures in Native American communities. Shown here are participants in a Zumba class. Photo Courtesy of Indian Health Service.

Jared Eagle runs one of those localized efforts as director of the Ft. Berthold Diabetes Program on the Ft. Berthold Indian Reservation in Nort Dakota. He said the rural area he represents cover 250 square miles – including the Mandan, Hidatsa, and Sahnish Nation and six communities – with much of the population living on the reservation. Many lack access to healthy foods.

“We definitely do live in a food desert,” Eagle said.

The community is made up about 7000 people, with 13% rate od diabetes. At least 21 people have kidney disease. The nearest hospital is approximately 80 miles away, those who need specialized care for diabetes or kidney disease sometimes have to travel up to 150 miles, or 2 hours by a vehicle to Bismarck.

“We’re very rural,” he said. “Our patients don’t have access, like the rest of the country. It’s getting out to those people, identifying them and getting the resources.”

Ft. Berthold has one main health center and several satellite clinics, some of them no bigger than a single room. A diabetic specialist travels to the region once a month to examine patients. Eagle said part of the program helps patients navigate the healthcare process or travel to appointments that can be hours away.

The area also has one main pharmacy and a small laboratory for basic work. The program has helped fund fitness centers in various parts of the reservation but many of the people who live in the community are overweight, Eagle said.

“The thought process is that if you’re not overweight, you’re kind of out of the norm,” he said.

Much of the SDPI funding in Eagle’s district has gone to preventative measures targeting the, 1300 school students in the community. This includes regular blood tests that look for signs of diabetes, screenings for height and weight and a range of programs that urge healthier lifestyles.

Eagle said some those lessons are spilling over into the community at large, including among adults, with people over 40 having significantly higher rates of diabetes and kidney disease.

“We’re getting the promotion out and the people are starting to recognize it and look forward to it,” Eagle said. “We’re starting to see effects of that.”

I’m fortunate that I live here in Frederick, MD. There is a hospital about a mile from here. They have diabetic clinics all over this town. If I can’t walk there, I can always catch the bus.

I did not know that Native American is the #1 group who get diabetes. Before I did this research I always thought that African American was #1 group who get diabetes.





2 thoughts on “National Institute of Diabetes and Digestive and Kidney Diseases

  1. Thank you Roger for the post. My grandpa and my great grandpa had diabetes. It is great to know that there are people like Jared Eagle doing positive things to improve the health of his community. More people around the world should have and support initiatives like this.

    1. I never heard of Jared Eagle until I did this research. I’m glad that they are people like Jared Eagle in places like the Dakotas to help people who can’t get to a hospital or a clinic.

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