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IHS grant to fund diabetes risk and asthma studies

OMAHA, Neb. -- The Northern Plains Tribal Epidemiology Center recently
received a Native American Research Center for Health grant from the IHS.
The Northern Plains Tribal Epidemiology Center is partnering with the
University of Nebraska Medical Center for the study.

The goal of the four-year grant, expected to total between $900,000 and
$1.5 million, includes two research projects to build trust and facilitate
research between American Indians and academic institutions. One of the
projects will look at diabetes risk in Native youths and what can be done
to prevent it. The other project is aimed at understanding asthma in Native

"The grant presents an unparalleled opportunity to conduct health research
where partnership with tribal communities and building tribal capacity are
at the foundation," said Francine Romero, director of the epidemiology
center and principal investigator for the NARCH grant. "Our collaboration
with the University of Nebraska Medical Center will undoubtedly bring
tangible benefits to tribes."

The center focuses on health research in tribes and is funded by the IHS.
The center, which serves 18 tribes in North Dakota, South Dakota, Nebraska
and Iowa, was established by the Aberdeen Area Tribal Chairman's Health

Dr. Jennifer Larsen, professor and section chief, UNMC diabetes,
endocrinology and metabolism, said the project will focus on decreasing
health disparities, facilitating research, decreasing distrust and training
researchers in American Indian communities.

"This is another step in how we're trying to show universities can work
with tribes to attack problems that they think are important, in ways that
may be most effective and helpful to them," said Larsen, principal
investigator of the diabetes risk project. "The idea is to establish a
long-term relationship to work on more than one problem."

Diabetes is almost an epidemic in all communities, but particularly the
Native community. The prevalence of type 2 diabetes, the most common form
of diabetes, is more than twice as common in American Indians as in
non-Hispanic white populations, Larsen said. "They also are at higher risk
for diabetic complications, especially amputations and end-stage renal
disease, and are more likely to die from complications of diabetes."

The prevalence of diabetes is increasing across the United States, but the
greatest increases have been seen in American Indian youths ages 15 -- 19.
She said programs have been initiated in many tribes to try to reverse this
trend but depend on identifying those at risk.

"We are now seeing new onset of diabetes in younger and younger ages,"
Larsen said. "A lot of the data we have about prevalence of diabetes and
pre-diabetes is based on those who make it to the physician's office. There
may be a lot of kids who are at risk whom we're not even seeing.

"This is a whole new thing to have diabetes starting so early. We're seeing
an epidemic of new onset of diabetes type 2 affecting the whole

The prevalence of diabetes is increasing and varies from tribe to tribe,
but is about 9 percent in adults for the Great Plains tribes, which is
double that described for surrounding states. The prevalence of diabetes
across Nebraska has increased in the Great Plains tribes by 16 percent from
1990 -- 1997, Larsen said.

The diabetes project will evaluate the prevalence of insulin resistance in
children of the Rosebud Sioux tribe. The goal is to identify the best
predictors in children who might be at risk for diabetes, with the ultimate
goal of preventing the onset of diabetes.

"There really haven't been that many studies to date that really identify
the prevalence of diabetes and pre-diabetes. With this study, we hope to
gain a more accurate representation of why Native American youths are at
higher risk than youths in other groups. Is it just related to disparities
in the prevalence of obesity -- there is some evidence this is true -- but
are there other disparities to explain why higher risk for diabetes?"

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Three hundred children, ages 5 to 18, will be screened on the Rosebud Sioux
reservation in south-central South Dakota. The Rosebud Clinic will serve as
the primary study site.

Researchers will use traditional diabetes screening tools that might
identify kids at risk, such as body mass index, family history and newer
screening tools, including stress screening. She said if stress is part of
the risk of developing diabetes, an intervention can be developed to better
identify a successful intervention.

"Which of these is the most sensitive for identifying children at risk has
not been well-studied," said Larsen. "Better information on which is the
easiest and most sensitive at identifying those at risk would be a great
value in efforts to change outcomes in high-risk populations," Larsen said.
"There's very little data about the relative risk of diabetes in Native
American kids, the best way to screen for it and the best way to
intervene," she said.

Researchers don't know why diabetes is increasing in American Indian

"Could it be that kids on reservations have more stress and that is the
reason we're seeing more obesity and diabetes? One of the things we're
looking at is stress as a potential cause. We want to find out if there are
specific stressors that hadn't been identified. This may change how we
intervene to prevent and treat diabetes," Larsen said.

Researchers will add a unique component to the grant: depression screening.

Larsen said depression and stress can be detrimental to diabetes.

"Depression and stress causes you to make extra hormones -- adrenalin, for
example. Almost all the stress hormones inhibit insulin action. If you make
the insulin, it doesn't work as well so you have to make more -- kind of
like type 2 diabetes. When some people have stress, they decide to eat
because it makes them feel better, so if you're eating more, that also
contributes to insulin resistance."

She said sedentary behavior contributes to insulin resistance.

"Insulin resistance may be a direct result of stress hormones or it may
indirect because the change of behaviors such as eating and activity
behaviors. This also can lead to depression, which can increase stress
hormones. It may be all of the above.

"The hope is the info we develop will be available to and valuable to the
tribes and lead to more information that will improve on interventions we
already have to more effectively prevent diabetes not only in youths but
also adults as well."

In addition, the grant will look at whether involvement of youths in
traditional and cultural activities of the tribe may serve as factors that
protect against risk of insulin resistance.

The asthma project of the grant involves screening for asthma in northern
Plains tribal communities to identify the prevalence of risk of asthma in
children that have not been diagnosed with asthma. The project's objective
is to determine the number of asthmatic children currently undiagnosed, and
identify those who aren't receiving the appropriate level of care for their

For more information about the study, contact Romero at (605)721-1922 or