Diabetes and Native Americans and Alaska Natives

About nine percent of American Indians and Alaska Natives have been diagnosed with diabetes. On average, they are 2.8 times as likely to have diagnosed diabetes as non-Hispanic whites of a similar age.

Diabetes mellitus is one of the most serious health challenges facing American Indians and Alaska Natives in the United States today. The disease is very common in many tribes, and morbidity and mortality from diabetes can be severe. This population includes all people who derive their origins from any of the original peoples of North America and who continue to maintain cultural identification through tribal affiliations or community recognition. Great diversity in culture, language, location, lifestyles, and genetic heritage exists among American Indians and Alaska Natives. More than 500 Native American tribal organizations, with many differences in language and culture, exist in the United States.

In 1990, the U.S. Census Bureau used self-identification to classify people as part of this group. The American Indian and Alaska Native population was estimated at about 2 million. Between the 1980 Census and the 1990 Census, a 38 percent increase occurred in the number of people who identified themselves as American Indians or Alaska Natives. This increase reflects an actual rise in the number of people who identify themselves as part of this group, as well as improvements in counting methodology. In 1990, more than half of the American Indian and Alaska Native population lived in the following seven States: Alaska, Arizona, California, New Mexico, North Carolina, Oklahoma, and Washington. The 1990 Census in Alaska showed a total of 85,698 self-identified Alaska Natives. Alaska Natives include three main population groups: Eskimo, Indian, and Aleut. Within these three groups are further divisions based on geographic location, and linguistic and cultural differences.

Within the estimated two million self-identified American Indians, about 1.2 million live on 33 reservations served by the Indian Health Service (IHS). Increasingly, tribal organizations are contracting directly with the Federal Government to operate health care facilities on reservations. The following data on American Indians are drawn primarily from information about American Indians living on reservations, not from American Indians living outside of the reservations.

Diabetes mellitus is a group of diseases characterized by high blood levels of glucose. It results from defects in insulin secretion, in insulin action, or both. Diabetes can be associated with serious complications and premature death, but people with diabetes can take measures to reduce the likelihood of disability and death.

Most American Indians and Alaska Natives with diabetes have type 2 diabetes, which usually develops in adults but can develop in children or adolescents. Type 2 diabetes is caused by the body's resistance to the action of insulin and by impaired insulin secretion. It can be managed with healthy eating, physical activity, oral diabetes medications, and/or injected insulin. Until recently, type 2 diabetes was rarely diagnosed in children and adolescents. However, type 2 diabetes is now common in American Indian children age 10 and older. A small number of American Indians (about 2 to 4 percent) have type 1 diabetes, which usually develops before age 20 and is managed with insulin, healthy eating, and physical activity.

Diabetes can be diagnosed by three methods:

• A casual (random) plasma glucose value of 200 milligrams per deciliter (mg/dL) or greater in people with symptoms of diabetes.

• A fasting plasma glucose test with a value of 126 mg/dL or greater.

• An abnormal oral glucose tolerance test with a 2-hour glucose value of 200 mg/dL or greater.

Each test must be confirmed, on another day, by any of the above methods.

Type 1 diabetes is relatively rare in American Indians and Alaska Natives. Most cases of type 1 diabetes are seen in people who have both American Indian and Caucasian heritage.

About nine percent of American Indians and Alaska Natives have been diagnosed with diabetes. On average, they are 2.8 times as likely to have diagnosed diabetes as non-Hispanic whites of a similar age. The available data probably underestimate the true prevalence of diabetes in this population. For example, 40 to 70 percent of American Indian adults age 45 to 74 were found to have diabetes in a recent screening study in three geographic areas. Data from the Navajo Health and Nutrition Survey, published in 1997, showed that 22.9 percent of Navajo adults age 20 and older had diabetes. Fourteen percent had a history of diabetes, but another seven percent were found to have undiagnosed diabetes during the survey.

Type 2 diabetes is becoming increasingly common in youth. Researchers studying 5,274 Pima Indian children from 1967 to 1996 found that the prevalence of type 2 diabetes in girls age 10 to 14 increased from 0.72 percent in the period 1967 to 1976 to 2.88 percent in the period 1987 to 1996. Current reports include an increasing incidence in First Nation populations in Canada.

Of the 2.3 million self-identified American Indians/Alaska Natives who receive care from the IHS, about 70,000 had diabetes in 1998.

Diabetes is particularly common among middle-age and older American Indians and Alaska Natives. Its prevalence in American Indians and Alaska Natives, compared with that of non-Hispanic whites by age group and sex.

In Pima Indians, the most widely studied American Indian group, the prevalence of type 2 diabetes was approximately 50 percent in individuals age 30 to 64.During the period from 1986 to 1993, the prevalence of diabetes in Alaska Natives for all ages (adjusted to the 1980 U.S. population) increased by 29 percent, from 15.2 to 19.6 cases per 1,000 people. Of these, most had type 2 diabetes.

The prevalence of type 2 diabetes in Alaska Natives varies by subgroup:

• Eskimo groups (Inupiaq Eskimos in the northern and northwestern coastal areas and Yup'ik Eskimos in the southwestern coastal regions and St. Lawrence Island) had a prevalence of 12.1 per 1,000 in 1993.

• Indian groups (Athabascan in the interior region; Tlingit, Haida, and Tsimshian in the coastal areas) had a prevalence of 24.3 per 1,000 in 1993.

• Aleut groups (residents of the Aleutian Islands, the Pribilof Islands, the western tip of the Alaska Peninsula, the Kodiak area, and the southcentral coastal areas) had a prevalence of 32.6 per 1,000 in 1993.

Two categories of risk factors increase the chance of typ

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