American Indians, Alaska Natives and Diabetes
In 2007, American Indians and Alaska Natives numbered about 3.3 million people, or 1.5 percent of the U.S. population. American Indians comprise about 96 percent of this ethnic/minority group. There are over 500 tribal organizations in the United States, with many differences in language and culture.
Type 1 diabetes is relatively rare in American Indians and Alaska Natives, whereas type 2 diabetes is the most common form of diabetes in this group of people.
In 2002, approximately 30 percent of American Indians and Alaskan Natives ages 55 years and older had diabetes. The overall prevalence of diabetes among American Indians and Alaska Natives combined is approximately 16 percent. On average, they are 2-3 times as likely to have diagnosed diabetes as non-Hispanic whites of similar age. Available data may underestimate the true prevalence of diabetes in American Indians. For example, data from the Navajo Health and Nutrition Survey, published in 1997, showed that about 23 percent of Navajo adults had diabetes, one-third of whom had not yet been diagnosed.
Diabetes is particularly common among middle-aged and older American Indians and Alaska Natives. Among the Pima Indians of Arizona, about 50 percent of people between the ages of 30 and 64 have diabetes. Diabetes rates are highest in Pima children whose parents developed diabetes at an early age. Until recently, type 2 diabetes was rarely diagnosed in children and adolescents. However, it is becoming increasingly common among American Indian children ages 10 and older.
The death rate for diabetes in American Indians is estimated to be 3 times the rate in non-Hispanic whites. Diabetes contributes to several of the leading causes of death in American Indians: heart disease, cerebrovascular disease, pneumonia, and influenza.
The rate of complications – kidney, eyes, amputation, periodontal disease – is also higher for this group. The rate of end-stage renal disease (the final stage of kidney disease associated with kidney failure and dialysis) in American Indians and Alaskan natives with diabetes has been estimated to be 3.5 times higher than in non-Hispanic whites. In Pimas, it is the leading cause of death. One study showed a 49.3 percent prevalence of diabetic retinopathy in Oklahoma Indians. Diabetic retinopathy is a deterioration of the blood vessels in the eye caused by high blood glucose levels and can lead to impaired vision and, ultimately, to blindness. Rates of lower extremity amputation are high in some American Indians but vary by tribe. The incidence of periodontal disease is 2.6 times higher in Pima Indians with diabetes than in those without it.
Excerpted and adapted from the Diabetes in American Indians and Alaska Natives Fact Sheet (National Institute of Diabetes and Digestive and Kidney Diseases), the Centers for Disease Control and Prevention, and the Indian Health Services (IHS) fact sheet.
Reviewed by Jason C. Baker, M.D. 06/11.
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Like many of us who live near major cities, I've been to a few ADA Diabetes Expos — my first in November, 2003, just over a year after diagnosis. The Expo took up a large part of New York City's Javits Center; most of the major meter, insulin, pump, and pill manufacturers were there; there were enough food vendors (with free samples!)...