Type 2 diabetes mellitus (T2DM) disproportionally affects American Indian/Alaska Native (AI/AN) communities as well as many Indigenous populations globally.
In the recent Annual Review of Public Health article, titled “Advancing Diabetes Prevention and Control in American Indians and Alaska Natives,” Drs. Julie E. Lucero (PhD) and Yvette Roubideaux (MD, MPH) discuss the context behind, the epidemic of diabetes in AI/AN communities and highlight the impact of the Special Diabetes Program for Indians (SDPI) on prevention and control of diabetes as well as the translation of these strategies into clinical practice and their influence on health practice.
The historical and political context that have contributed to health disparities for AI/AN communities can be traced back to early US policies such as relocation, boarding schools, and underfunding of health services for AI/AN communities. Consequently, the disruption of traditional lifestyle and environmental changes contributed to health disparities within the individual, interpersonal and environmental level that are difficult to overcome.
Given this context, interventions should be multifaceted and geared towards addressing the different levels of disparities produced from federal relocation of tribes. The Special Diabetes Program for Indians (SDPI), first established by congress in 1997, “…was designed to be community-driven, and interventions were based on best practices and adapted to the local community needs,” said Lucero and Roubideaux.
Along with the community-based interventions, the SDPI DP program (Translation project mirroring SDPI) incorporated an intensive curricular phase that supported “one-on-one case management lifestyle coaching to determine participants’ needs and goals, developing individualized nutrition and physical activity plans, and identifying and solving participation barriers”.
This transdisciplinary study proved to be effective in improving AI/AN health outcomes as a result of identifying individual, social and environmental factors leading to adverse experiences. “The SDPI program’s impact on the prevention and treatment of diabetes in AI/AN communities is clear, and the evaluation of this program over the two-decade intervention has helped investigators track and understand outcomes,” said the authors.
“Of the 2,553 participants who enrolled by July 2008, 74% who completed all 16 sessions had a significantly lower incidence of a diabetes diagnosis, with a crude rate of 3.5% among completers compared with non-completers at 7.5%,” they added.
“These interventions illustrate the need to adapt the diabetes prevention strategies and concepts to the local context to create better chances for positive outcomes. These examples also demonstrate the effectiveness of framing interventions to consider, and adapt from, lessons from epidemiologic, historical, and social ecological contexts to produce outcomes that stem the tide of diabetes in AI/AN communities.”