Western Tribal Diabetes Project

In 2002, 15.3% of all adult American Indian and Alaska Native (AI/AN) IHS users had diabetes, more than twice the level in U.S. adults overall (7.3%). These prevalence figures represented a dramatic increase, both for AI/AN IHS users – where the prevalence of diabetes was 11.5% in 1994 – and for the US general population – where the prevalence of diabetes was 4.8% in 1994.4 The number of AI/ANs younger than 35 who were diagnosed by the IHS more than doubled between 1994 and 2004, from 6,001 patients to 12,313. Overall, the prevalence of diagnosed diabetes among AI/ANs under 35 was about 1.7% in 2004.

Increases in the level of diagnosed diabetes may be partly due to enhanced screening through the Special Diabetes Program for Indians (SDPI), implemented in 1997. While the level of diagnosed diabetes has been on the rise, intermediate outcomes have improved for IHS diabetes patients since the start of the SDPI. Recent analysis of the Annual Diabetes Care and Outcomes Audit showed improvements in mean Hemoglobin A1c, blood pressure, and cholesterol levels.

In the Northwest, about 11.2% of adult tribal enrollees said they had been diagnosed with diabetes (not including gestational diabetes) in a 2001 survey. Diabetes increased with age, to almost a third (31.5%) of AI/ANs 60 years and older reporting a diagnosis. More than half of tribal members had been tested for diabetes in the previous five years (57.1%).

The Diabetes Management System (DMS) can be a rich source of information for tribes that use the Resource and Patient Management System (RPMS). Check with the local diabetes program or RPMS site manager to find out if the DMS is in use.

1. National Diabetes Information Clearinghouse (NDIC). Your Guide to Diabetes: Type 1 and Type 2.  http://www.diabetes.niddk.nih.gov/dm/pubs/type1and2/index.htm.
2. The Unofficial IHS Diabetes Care & Outcomes Audit Support Site. IHS Standards of Care for Patients with Type 2 Diabetes.  http://www.dmaudit.com/socfork.htm.
3. Indian Health Service Division of Diabetes Treatment and Prevention. Clinical Guidelines for Adults with Prediabetes and/or the Metabolic Syndrome.  http://www.ihs.gov/MedicalPrograms/Diabetes/index.asp.
4. Diabetes prevalence among American Indians and Alaska Natives and the overall population—United States, 1994-2002. MMWR Morb Mortal Wkly Rep. Aug 1 2003;52(30):702-704. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5230a3.htm.
5. Diagnosed diabetes among American Indians and Alaska Natives aged <35 years–United States, 1994-2004. MMWR Morb Mortal Wkly Rep. Nov 10 2006;55(44):1201-1203. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5544a4.htm
6. Wilson C, Gilliland S, Cullen T, et al. Diabetes outcomes in the Indian health system during the era of the Special Diabetes Program for Indians and the Government Performance and Results Act. Am J Public Health. Sep 2005;95(9):1518-1522.
7. Romero F, Hasty F, Rose R, et al. Northwest Tribal Behavioral Risk Factor Surveillance System (BRFSS) Project, Aggregate Final Report. Portland, OR: Northwest Portland Area Indian Health Board; 2003. Full report available for download from this website under “Resources – Reports”.

The WTDP consists of two divisions: Northwest and National. WTDP delivers its services through support from our Portland offices and site visits to participating tribes. During the site visits WTDP staff provide hands-on training and support. Most sites receive at least two site visits.

Working with participating tribes, WTDP uses a step-by-step approach for diabetes data improvement.