Halting the diabetes epidemic among American Indians and Alaska Natives: Voices from the Tuba City Diabetes Prevention Program

Type 2 diabetes is a serious and costly disease affecting Native Americans at significantly higher rates than the general U.S. population. Moreover, this population experiences a disproportionate amount of diabetic complications. Despite the current epidemic of diabetes among American Indians/Alaska Natives (AI/AN), little data are available on culturally appropriate, community-based prevention programs. Recognizing the magnitude of this problem, Congress augmented monies to the Special Diabetes Program for Indians to fund a diabetes prevention demonstration project. The activities of the demonstration project are based on the Diabetes Prevention Program (DPP), a large research study which showed a 58% reduction in the progression of prediabetes to diabetes by eating a low-fat diet, losing a moderate amount of weight, and exercising regularly. The demonstration project hopes to determine if the DPP is effective in real-world native settings. Tuba City, a rural community on the vast Navajo reservation in Arizona, was chosen as one of 36 sites to participate in the demonstration project. The 16-lesson DPP curriculum is delivered in a group format to participants diagnosed with prediabetes. The first cohort of Tuba City DPP graduates were interviewed to obtain qualitative data regarding diabetes perceptions and experiences of the program. Five major themes were identified: the central role of family; the importance of self-efficacy and empowerment; the commonality of mental health issues; perceived changes due to participation; and program evaluation information. Study findings shed light on some of the critical elements necessary for halting the diabetes epidemic among native populations.