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Diabetes: Changing what's considered normal

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Here is some really bad news: the rates of adults diagnosed with diabetes have reached 60 percent in some Indian communities. Statistics for younger people are even grimmer: diabetes rates for 15- to 19-year-olds in Indian country more than doubled between 1990 and 2004. The rates for kids 15 and younger increased by 75 percent. It is our new ''normal.''

The good news is that Indian communities are addressing this alarming problem with programs that are making a real difference in the battle to prevent and treat type 2 diabetes. This was the testimony of National Indian Health Board Vice Chairman Buford Rolin, who spoke Feb. 8 before the Senate Committee on Indian Affairs at an oversight hearing on the Special Diabetes Program for Indians.

SDPI is a grant program for the prevention and treatment of diabetes; grant recipients are the IHS, tribes and tribal organizations, and urban Indian organizations. A renewed advocacy campaign is critical to the program's future: the $150 million that Congress appropriated for SDPI funding will expire in October 2008 and must be reauthorized in order to continue. NIHB is expected to request reauthorization of SDPI at $200 million for five years.

Rolin drew focus on the 400 prevention programs that exist throughout Indian country as a result of SDPI funding. A quick search of these programs demonstrates community action at its best. Many incorporate traditional diets and activities in their curricula, such as social dancing, community gardening, paddling and hiking. Rolin, chairman of the Poarch Band of Creek Indians, is also chair of the Tribal Leaders Diabetes Committee. He invited the committee to visit Indian communities so members can see for themselves what a positive role SDPI plays in battling the diabetes epidemic.

SDPI was created in 1997 to address the ''alarming trends of disproportionately high rates of type 2 diabetes in Alaska Native and American Indian communities.'' The grant program is the largest of its kind in the history of the IHS. Much of its success is owed to the relative freedom with which participating communities can choose what works for them, says Dr. Yvette Roubideaux, M.P.H., co-director of the SDPI Demonstration Project Coordinating Center. ''Most are tribal programs, communities finding their own ways,'' she said, ''It's important for people to share their stories with each other.''

We couldn't agree more. The period of oral testimony has closed, but there remains a narrow window for contributing your story. The congressional hearing record will remain open until Feb. 22. We join NIHB in strongly encouraging individuals, tribes and SDPI programs to send written statements, including personal stories of success and hope, to the committee for inclusion in the hearing record. Testimony can be sent to the SCIA clerk Marilyn Bruce at marilyn_bruce@senate.indian.gov. Be sure to send a copy of your testimony and letters to NIHB so it can be included in SDPI advocacy efforts. Those can be sent to Jaime Hale, legislative assistant for NIHB, at jhale@nihb.org.

Among SDPI's strengths is that it teaches people how they can prevent diabetes, and informs diabetics on ways to prevent complications associated with the disease. Unfortunately, many aspects of Indian life have stealthily contributed to the epidemic rise of diabetes. Limited access to basic resources such as healthy foods, adequate health services and safe environments for physical activity actually encourage obesity and have amounted to a ''new normal,'' Roubideaux said.

We've mentioned in the past that the only good thing about this scourge is that both ancient wisdom and scientific research provide us with reasonable paths to wellness: conscious, informed eating habits and a commitment to exercise as tools for prevention and management. Even so, it's hard to get people in Indian country to do this, according to Roubideaux. ''It's hard to get anyone to do it. We have come to accept obesity as normal in our culture,'' she said. ''We need to change what's considered normal.''

We all have heard the recommendations: get at least 30 minutes of activity, five days a week; reduce fat intake and eat fewer calories; lose 7 percent of your body weight. But it's worth repeating. These steps can reduce your risk of developing diabetes by nearly 60 percent. Incorporating these steps into community participation programs is the heart of SDPI.

In terms of prevention, screening is critical. About one-third of those with diabetes don't even know they have it. SDPI includes pre-diabetes screening for those with high-risk factors in their lifestyle. According to testimony by IHS Director Dr. Charles Grim, the sharp increase in the prevalence of diabetes in Indian and Alaska Native people can actually be considered a victory because the SDPI provided resources to make comprehensive health screening possible, revealing a far greater problem than was previously known.

It is not difficult to imagine the kinds of stories that might be included in the hearing record. Whatever your particular story, the threat of diabetes is ever-present and woven into our ways of life. Fortunately, Indian communities have a weapon - and we're using it to bring about a new ''normal.''