Successfully reducing diabetes disparities among urban Indians

Background: Diabetes is a significant, growing health crisis among American Indians and Alaska Natives (AI/AN). The AI/AN prevalence of diabetes is more than double that of the overall U.S. population, and the AI/AN mortality rate from diabetes that is nearly double that of the overall U.S. population. Regardless of reservation or urban residence, this disparity holds true for all AI/AN. Additionally, once virtually diabetes risk-free, AI/AN youth are now also increasingly threatened by Type 2 diabetes. Indian Diabetes programs provide essential screening and disease management services. For many AI/AN who reside in urban settings, Urban Indian Health Organizations (UIHO) are their primary provider of health care. The 34 UIHO nationwide receive Indian Health Service (IHS) grants including the IHS Special Diabetes Program for Indians, and provide culturally appropriate diabetes assistance. UIHOs are familiar with and responsive to the unique challenges of providing care to the urban AI/AN population. Objective: To examine the impact of the urban Indian health diabetes programs on the urban AI/AN population, to educate politicians, academics, public health officials, and the general public on urban Indian diabetes programs' outcomes, to increase awareness of the urban AI/AN population's health, and to recommend policies to improve urban AI/AN health. Methods: Data were collected from select UIHO covering years 2000 through 2005. Variables were determined by the IHS Standards of Care for Patients with Type 2 Diabetes. Findings from the analysis were provided to the Urban Indian Health Commission, a grouping of experts who merged their scientific, cultural, and policy expertise to produce a series of reports on urban Indian health including diabetes. Findings: Many significant health status improvements among the AI/AN population receiving UIHO care in the 2000-2005 period, including significant reductions in blood sugar levels (hemoglobin A1c) and harmful (LDL) cholesterol levels among diabetes patients. Also documented, a considerable decrease in blood pressure levels and a substantial increase in the number of flu vaccinations provided to diabetes patients. These statistics illustrate the effectiveness of treatment services on the management of diabetes-related clinical outcomes. Policy Considerations: Addressing diabetes-related health disparities directly aligns with the federal government's Health People 2010 goals to increase quality/years of health life and eliminate health disparities. For urban AI/AN, UIHOs represent an invaluable means of attaining these goals. However, UIHOs require ongoing, stable, and sufficient funding to maintain successes in diabetes control/management and effectively address the outstanding needs of diabetes management and care.