Friday, 24 January 2020

Indian Health Service – Changing the Course of Diabetes in Indian Country

Indian Health Service – Changing the Course of Diabetes in Indian Country
24 Aug

Dr Ann Bullock: Native Americans were among the first groups in this country to be hit by the diabetes epidemic that is currently now, in almost all populations, in this country

In response to the diabetes epidemic in American Indian/Alaska Native communities, in 1997, Congress established the Special Diabetes Program for Indians This program provides funding for our Indian Health Service, Tribal, and Urban programs to be able to prevent and treat diabetes at more than 300 sites across the country, in 35 states The good news is that diabetes prevalence in Native Americans has plateaued – it has not increased any further since at least 2011 In addition, a key complication of diabetes, like end-stage renal disease – which makes people have to go on dialysis – that has been reduced by over 54 percent This is an incredible reduction! Similarly, we're seeing that kind of reduction by more than half in new cases of diabetic retinopathy, the eye disease of diabetes

So, the outcomes of the Special Diabetes Program for Indians, and other efforts in clinical care and prevention services, are having tremendous impact, just as Congress asked us to do in 1997, which was to change the course of diabetes in Indian country That is exactly what is happening Shondra McCage: So prior to SDPI funding, Chickasaw Nation had one nurse, and he worked part- time doing just some diabetes education After SDPI, we were able to fund our current center staff, most of the staff is paid for by SDPI funds But with support from our Tribal leadership and our health care administration, we do have some other positions that have been filled to create our whole team

We're really proud that our diabetes care center is known as a comprehensive center We consider it a one-stop-shop for diabetes care We do have an endocrinologist on staff, and three mid-level providers who can provide the medical treatment and care But in addition to that, we also have medical family therapist, a dietitian to help with nutrition education, an exercise consultant that's on staff We have a dental hygienist that works specifically just with our patients that have diabetes

They can get everything they need in one visit at that time, in one appointment When treating a patient – it really – there is so much more with diabetes care beyond just medications and checking blood sugars We know that sometimes our patients struggle with getting adequate foods or access to healthy, nutritious foods Nissa Harrington: Patients that are food insecure have a higher risk of developing diabetes, chronic disease, having more emotional problems related to their food insecurity, more depression It affects their clinical outcomes as far as their hemoglobin, A1C

That's what I tend to see a lot with my patients Shondra McCage: The IHS Division of Diabetes Treatment and Prevention, they hosted a webinar on food insecurity and provided a tool to use to screen for food insecurity And myself and our dietitian watched that webinar – we knew this was an issue for our patients – and we implemented that And it's now part of our dietitian's template Nissa Harrington: And so then when, the parameters do indicate that they could possibly have food insecurity, from there, I can refer to different food distribution programs that we have within the Nation, other Chickasaw nutrition services, and just based on the community that they live, other resources that are available to them

Dr Bullock: Because our American Native/Alaska Native communities are so concerned about the care of, and the health of each member of their community, that they not only place great emphasis on clinical care, but they also do outreach into their communities to educate, not only individual patients, but whole communities about how to take good care of themselves and to help prevent and effectively manage diabetes Shondra McCage: So, at the clinic, when we're working with our patients, we really encourage them to bring family members so we can help incorporate the whole family Diabetes doesn't just affect one person, it is a family affair We allow them to come in, and we invite them to come in, to attend our education programs with the patient

We host a diabetes camp that's family involved Any of our community events, of course, are always family oriented Dr Bullock: It's this kind of passion, community involvement, and cultural perspective that allows these programs to be so successful When SDPI began 20 years ago, we were afraid that this disease would decimate our communities

We no longer have to hope that we can change that trajectory; we are seeing that changing in meaningful ways every day now, both at the local level, and across the country We're seeing reductions in the complications of diabetes and at least a leveling off of prevalence of diabetes in our communities This means healthier American Indian/Alaska Native people and communities now and for the generations to come [Music]


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