Mark Trahant: 'So much progress' treating the diabetes epidemic in Indian Country

Thursday, June 27, 2019  

Dr. Yvette Roubideaux took a quick poll Wednesday from the podium at the National Congress of American Indians mid-year meeting in Sparks, Nevada.

“How many of you think we've made great progress with American Indians and Alaska Natives with diabetes? Raise your hand.”

A few hands went up. “How many think we still have more to do?”

Far more hands in the air, followed by, “how many of you think that diabetes is still a significant crisis in our communities?”

Nearly every hand went up.

For the record Roubideaux agreed with all three premises. Indian Country has made extraordinary progress on the diabetes front even though there remains a long way to go before the disease is under control. But at the same time there has been extraordinary progress.

Indian Country still shows the highest rate of diabetes; Native Americans are twice as likely to get diabetes as other population groups.

“The big picture is that we've seen amazing outcomes in the prevention and treatment of diabetes over the past 20 years,” Roubideaux told Indian Country Today. She credits the Special Diabetes Program for Indians as a key element in that success. Roubideaux, Rosebud Sioux/Standing Rock Sioux, is director of the NCAI Policy Research Center in Washington, D.C.

“The proportion of people with diabetes who are American Indians and Alaska Natives has not increased since 2011. It's amazing results,” she said. “We've seen the mortality for diabetes and American Indians and Alaska Natives go down. And most exciting is the complications for diabetes are going down.”

The data shows a sharp decrease in the complications associated with diabetes, such as a 54 percent drop in kidney failure, according to the Centers for Disease Control and Prevention. More than 300 tribes are engaged in diabetes education, exercise programs, or nutrition initiatives and 66 are funded directly through the Special Diabetes Program for Indians.

Another data point is the reduction in glucose levels for American Indians and Alaska Natives. This, she said, is like the “gold star” from the Special Diabetes Program for Indians because of the decrease blood glucose means better diabetes care. “There actually had been decrease complications … going down faster than all the other racial and ethnic groups.”

The data is showing the success of these programs, especially when it comes to reducing diabetes-releated complications through better care.

An issue brief by the U.S. Health and Human Services Office of the Assistant Secretary for Planning and Evaluation translated the data into “cost savings” for taxpayers through Medicare. Permanent kidney failure, also known as end-stage renal disease, is covered by Medicare.

“Under our relatively conservative assumption,” the agency observed, the overall reduction in kidney-related issues estimated an accumulated Medicare savings between 2006 and 2015 of $435.9 million. To put that number in context, the Special Diabetes Program for Indians is funded at $150 million per year.

The Centers for Disease Control and Prevention says one reason for the slowing diabetes rates is because the Indian health system uses a team based-care approach that includes “patient education, community outreach, care coordination, tracking of health outcomes, and access to healthcare providers, nutritionists, diabetes educators, pharmacists, community health workers, and behavioral health clinicians.”

At the NCAI conference, Dr. Roubideaux made that point that best practices do lead to better outcomes in diabetes prevention.

“If you attended more of the 16 week classes, you have a lower risk of diabetes,” she said. If you attended more case management visits, you had lower risk factors for diabetes and better care means better outcomes.

Roubideaux told delegates about her visits to the Zuni Pueblo. In the 1990s we were there to look at their dialysis center and 18 beds running all the time. “It was really sad,” she said.

Then she visited in 2013 or 2014 and the pueblo had summer programs for youth doing soccer and exercise. They had programs where kids learn how to garden and they had wellness camps. “I got to watch a group of probably four to eight year olds doing the Zumba class,” she said. “I have to admit it was very emotional because 20 years earlier I had been in that community and I noticed all the obesity and the kids, these kids doing the Zumba class were normal weight and that's a great start for their futures and for the community as a whole.”

And if you multiply that story across 573 tribes across the country it shows how an epidemic can be defeated.

“Okay, so now let's turn the tide,” Roubideaux said. “But let's think about the questions at the beginning. We still have an epidemic going on. We still have serious issues in our communities. We still, despite these great outcomes, we still haven't moved to end disparities.”

Mark Trahant is the editor of Indian Country Today. He is a member of the Shoshone-Bannock Tribes. Follow him on Twitter @TrahantReports.

This story originally appeared on Indian Country Today on June 26, 2019.