National Diabetes Month
Margo Kerrigan, M.P.H., Area Director
Indian Health Service California Area Office
November 2005 - November is National Diabetes Month and we who work in Indian health know that diabetes is a significant burden in the American Indian/Alaska Native (AI/AN) population. In 2003, more than 99,500 AI/AN aged 20 years or older (12.8%) who received care from IHS had diabetes. AI/AN are 2.2 times more likely to have diabetes as non-Hispanic whites. Among the general American population there is a growing diabetes epidemic with an estimated 20 million people with diabetes. Each day, there are more than 4,000 new cases of diabetes.
Diabetes is a chronic disease and has no cure. It is marked by high blood glucose levels caused by defects in the body's insulin action and/or production. Diabetes can cause serious complications such as heart disease and stroke, high blood pressure, blindness, kidney disease, nervous system damage, amputations, dental disease, sexual dysfunction, and pregnancy complications. Diabetes is the fifth leading cause of death in the United States and heart disease is the number one cause of death for AI/AN with diabetes.
How can we combat this diabetes tsunami in AI/AN communities? By increasing diabetes awareness in our communities, diagnosing diabetes early, teaching patients with diabetes how to manage their disease, and offering the highest standard of diabetes care in our clinics.
The federally-funded Special Diabetes Programs grants from IHS support the diabetes care efforts of California urban and tribal Indian health programs. These funds help support diabetes education programs that teach patients how to manage their diabetes through lifestyle (diet and exercise), self-monitoring of blood glucose values, and adhering to medication regimens. Working as a team, AI/AN with diabetes and their health care providers can reduce the occurrence of diabetes complications by controlling levels of blood glucose, blood pressure, and blood lipids.
In addition, each patient should receive preventive care as specified in the American Diabetes Association/Indian Health Service Standards of Diabetes Care. The annual IHS diabetes audit is a measure of how clinics meet these Standards of Care. California Area data from the 2005 IHS diabetes audit show steady improvement over data of previous years.
The number of active diabetes patients with blood glucose levels at goal (HbA1c < 7.0%) was 41%, compared to 37% in 2004. Blood pressure control was optimal in 35% of patients, up from 32% in 2004. Use of medications to prevent heart disease (ACE inhibitors, aspirin and antiplatelet agents, and lipid-lowering medications) increased by 4 to 8% from the previous year. Laboratory testing for blood lipid values and kidney function went up. Education in diet and exercise increased by 8% and 12%, respectively. Three-quarters of patients are testing their blood sugars - more than ever, and by doing so they are taking the driver's seat in managing their diabetes.
The data show we are on the right track. But we need to do more.
California Indian health care clinics are using their annual audit data to set goals for improving diabetes care for their clients. And clinics are starting diabetes prevention programs, largely because their communities are asking for assistance in stopping this debilitating disease.