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Nearly epidemic proportions of diabetes spur Cherokee prevention program

TAHLEQUAH, Okla. ? Soaring diabetes rates among the Native American population in Oklahoma, and throughout Indian country, prompted the Cherokee Nation to take an offensive position by reaching out to children through education.

By identifying those most vulnerable to the disease at an early age, health care providers hope to prevent the onset of diabetes in young people through education and changes in diet and lifestyle.

The Chronic Disease Service in Oklahoma reported that type 2 diabetes affects more than 200,000 Oklahomans and the rise of more than 4 percent in less than four years has health care workers throughout Oklahoma concerned.

The Cherokee Nation is typical of Native American populations throughout Indian country with rates of diabetes running between 35 to 40 percent of tribal members diagnosed with the deadly disease.

Although diabetes has been a modern plague for Native Americans, the emerging epidemic of children and adolescents is fairly recent. Obesity and lack of exercise, along with a family history of the disease are three of the reasons seen for the rise in type 2 diabetes throughout the state.

By going into schools and finding children at risk for the disease, the Cherokee Nation's health providers hope they can begin to turn the statistics around. Through their education program, public health officials believe that instead of seeing young people in their 20s and 30s diagnosed with type 2 diabetes, they may be able to postpone the onset of the disease for 40 or 50 years.

During screening to identify those most at risk, health care providers look not only at obesity and family histories, but also for signs of acanthosis nigricans, often called 'dirty neck syndrome.' This is a darkening of the skin on the neck or in other skin folds on the body and it does not mean that someone has diabetes, but it does mean there is an increased chance of the disease.

Young people who are overweight and have "dirty neck syndrome" have the highest risk of developing the diabetes at a young age. Parents can identify acanthosis on their own children if the skin looks velvety and darkened. It may also feel thick and rough, is most common among teen-agers and adults and can be seen as early as age 10 on those in danger of getting diabetes. Common places to see the darkened skin are on the neck and under arms, but it can also be found in other skin folds.

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This precursor to diabetes can disappear if diet changes are made and an exercise program is set up to help young people lose weight.

"It doesn't mean they have diabetes, but it means their bodies are making an awful lot of insulin. We tell them it is a lifestyle change," Public Health Nurse Carolyn Holbird said.

"We don't want to tell young people to diet, instead we tell them to not have that bag of chips or that candy bar. It can take a hundred calories off their total intake and in the long haul that, along with more exercise, will help them lose weight and decrease their risks. Walking is as good an exercise as any."

Holbird has been on the front lines screening at-risk youth at schools in the Tahlequah area and said she hopes increased awareness of those they talk to will make lifestyle changes that could save their lives.

Holbird explained that going into schools, "We do their heights and weights, blood pressures, blood sugars, then we check for the dirty neck syndrome. Interestingly enough, nearly all of the children who had the dirty neck were overweight."

With more than 500 children screened so far, Holbird said that at one school alone some 126 children were found to be overweight.

"Thirty six of those children had the dirty neck," she said. "We talked with them together and explained diabetes. In the Indian population nearly everyone had a family member with diabetes. It is a very high percentage in the Native population. We then counseled them separately and went over each item that we had done ? and told them with their weight they were at a higher risk for diabetes."

The youngsters are then advised to get more exercise along with cutting out that extra bag of chips or soda and to get their weight down. Holbird and others involved in the prevention program are gearing up to go back and talk to students they screened last year to see if the changes have made a difference.

"It's a small step, but it's a start," she said.