The Centers for Disease Control and Prevention, in conjunction with the Indian Health Service, recently released promising new data for Native American diabetics. The Vital Signs report shows diabetes-related kidney failure among American Indian and Alaskan Native adults decreased by a substantial 54 percent between 1996 and 2013.
The federal health agencies credit the improvement on public health and population-based approaches—including a big focus on tribal community outreach—as well as improved diabetes management and better clinical care offered by IHS since the mid-1980s. Funding to support these efforts through the IHS Special Diabetes Programs for Indians (SDPI), currently funded at $150 million per year, has been key, officials said.
“Untreated or poorly controlled diabetes may result in kidney disease that progresses to kidney failure that requires either dialysis or kidney transplant,” noted CDC Director Tom Frieden in a January press conference call announcing the findings. “The approaches implemented by the Indian Health Service are applicable and scalable for all people with diabetes. When an approach uses a population-wide team-based methodology, even and especially in those disproportionately affected by diabetes, kidney failure can be delayed or prevented.”
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“The 54 percent decline in kidney failure from diabetes followed implementation of public health and population approaches to diabetes as well as improvements in clinical care by the IHS,” added Mary L. Smith, former IHS principal deputy director. “We believe these strategies can be effective in any population. The patient, family, and community are all key partners in managing chronic diseases, including diabetes.”
Smith said during the call that since 1997, there have been major successes in IHS efforts to improve diabetes care for Indians; between 1997 and 2013, the number of grantees from the IHS special diabetes program who have reported the availability of diabetes clinical teams had jumped from 30 percent to 96 percent, and adult weight management efforts increased from 19 percent to 78 percent. Other strong efforts include time off for tribal employees for diabetes education and exercise, better access to healthier foods, transportation to clinic visits, and health education and exercise classes, she said.
“Although some of IHS successes began before the special diabetes program initiative, the SDPI Program has made it possible for American Indian communities to sustain quality diabetes programs and care practices and has helped the Indian health system make tremendous improvements,” Smith added.
Frieden said that strong coordinated clinical care and education, community outreach and environmental changes can make a dramatic difference in reducing complications from diabetes for all Americans.
Diabetes is the leading cause of kidney failure nationwide, and Native Americans have a greater chance of having diabetes than any other U.S. racial or ethnic group. According to CDC data, about 2 in 3 Native Americans with kidney failure have diabetes, but the good news is that the rate of diabetes-related kidney failure in Native Americans has declined the fastest of any racial or ethnic group in the U.S.
While the kidney failure findings suggest that IHS interventions are having a positive impact for American Indians, Type 2 diabetes rates are still very high in the Indian population, indicating that it is a whole lot easier to curb kidney failure than it is to prevent Type 2 diabetes.
“It is somewhat less difficult to control the complications of diabetes than to prevent diabetes in the first place,” said Frieden. “We’re not clear—there’s no definitive evidence as to why diabetes is more common in some groups than others. We know that the rates are so much higher in Native Americans. We also know diabetes prevention programs work and can greatly reduce the progression from prediabetes to diabetes.”
Ann Bullock, director of the Division of Diabetes Treatment and Prevention at IHS, also said that while Type 2 diabetes rates are still highest among Native Americans, “our rates have actually flattened out and the beginning of suggestion of a decrease is starting to be seen. We hope this as a trend develops over the next few years. At the very least we know that it has flattened out.”
More key findings from the report, titled Vital Signs, as highlighted by IHS, include:
- Despite well-documented health and socioeconomic disparities in the Native American population, kidney failure from diabetes has decreased substantially since 1996.
- IHS-supported care for Native American diabetics has improved.
- Use of medicine to protect kidneys increased greatly, from 42 percent to 74 percent in 5 years.
- Average blood pressure in Native Americans with diabetes and hypertension is well controlled (133/76 in 2015).
- Blood sugar control improved by 10 percent between 1996 and 2014.
- More than 60 percent of Native American diabetics 65 years and older had a urine test for kidney damage (2015) compared to 40 percent of the Medicare diabetes population (2013).