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Organizations band together 'On the T.R.A.I.L.'

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By Robin Buda -- Today staff

CANASTOTA, N.Y. - The Boys & Girls Clubs of America joined IHS, the National Congress of American Indians and Nike to pilot a prevention program aimed at reducing the onset of diabetes among American Indian youth in the fall of 2002. Called On the T.R.A.I.L. (Together Raising Awareness for Indian Life) to Diabetes Prevention, it is an innovative combination of physical and educational activities. The program is still going strong and growing in numbers with each passing year.

Diabetes is a chronic disease in which the body does not produce proper amounts of insulin, a hormone needed to process food into energy for daily life, or becomes resistant to it. Whether Type 1 (usually diagnosed in children) or Type 2 (formerly known as ''adult-onset diabetes''), it can affect virtually every tissue of the body with long-term and severe damage.

Mark Piccirilli, president of FirstPic Inc., a consulting firm based outside of Washington, D.C., that has done work with Indian country for the last 15 years and helped coordinate this effort, spoke about how this program became a reality.

''It came about probably about five years ago at the request of the Indian Health Service and, at the time, of [then IHS Director] Charles Grim and special assistant Leo Nolan. The Indian Health Services were really concerned with the obesity issues in Indian country and the Type 2 diabetes issues they were finding across Indian country, and wanted to find a vehicle to develop a program that was both educational- and physical activity-based and wanted to see an avenue by which it could really get that program out; and the Boys & Girls Clubs in Indian country became that perfect vehicle because there are an excess of 200 clubs now serving about 150,000 kids across Indian country serving about almost 90 different tribes. And it became a natural vehicle for dissemination and distribution. ... We've been involved as kind of an architect and designer of the program and pilot testing it since its inception.''

The program isn't just preventive. While IHS really wanted to develop a prevention-based program so that the kids would understand at an early onset, it also wanted elements within that to pertain to children who already have diabetes.

''When they were finding some kids as young as 10 and 11 years old who were already diagnosed with Type 2 diabetes, that's what really was the emphasis to start the program,'' Piccirilli added.

It started with pilot testing in six American Indian communities and last year it was delivered in 40. The hope for this year is to deliver it to 60 different communities.

T.R.A.I.L. is a 12-week incentive-based program that provides youth with a broad understanding of healthy lifestyles in order to prevent diabetes. The program is presented with four themes: About ME and My Health; Diabetes and Nutrition; Making Smart Food Choices; and Sharing Knowledge With Others. Club members draw from tribal traditions and history to learn about nutrition, food choices and the impact of diabetes.

''It's multifaceted. It has an education component which is curriculum-based and teaches kids about diabetes and several different chapters that talk about many different factors,'' Piccirilli said.

''Indian Health Services was real interested in combining that with not only being an education-based program that talked to kids about what diabetes is and the proper nutrition, but also wanted to get kids physically active. It combines the education program, which is two days a week and about 45-minute sessions, with five days of physical activity a week based on the surgeon general's recommendation of the amount of activity for middle school kids.''

The physical activity component of the program is sponsored by Nike and provides incentives for the youth to keep up the good work. And it's not the only hands-on component: The education section lets kids get out there and test what they've learned.

One of the clubs teaches the kids how to read labels and look through the content of products. They then get to take a field trip to a grocery store to put their knowledge to work. At the end of one such session, the kids requested to have the Coca-Cola machines removed from the club because they didn't feel it was healthy.

''The kids do special projects under the program itself as well. ... And then at the end, after they graduate, they get certificates and they can come back and serve as peer leaders for other kids for the next round. And also, they're given a post-training opportunity. They're given journals called 'Still on the T.R.A.I.L.,' where they document what they've done after they graduate the program. They continue to exercise; they continue to eat right. They fill their journal and come back to the program coordinator at each club, and they're rewarded with some of the Nike incentives.''

This way, the youth don't lose the knowledge they've gained after the 12 weeks. The plan is for them to retain it for life.

''The hope for the program was really going to be a behavioral change for kids.''

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Diabetes: What to know


"Extreme thirst

"Frequent urination



"Flu-like symptoms


Source: Joslin Diabetes Center at Harvard Medical School

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"Increased thirst and frequent urination

"Extreme hunger

"Weight loss


"Blurred vision

"Slow-healing sores or frequent infections

Source: Mayo Foundation for Medical Education and Research


"Insulin: Hormone made by the islet cells of the pancreas. Insulin controls the amount of sugar in the blood by moving it into the cells, where it can be used for energy.

"Insulin resistance: Condition in which cells no longer respond well to insulin. The body responds by secreting more insulin into the bloodstream in an effort to reduce blood glucose levels. Exercise, weight loss and certain medications may reduce insulin resistance.

"Insulin sensitivity: The opposite of insulin resistance. It is the degree to which cells respond to a particular dose of insulin by lowering blood glucose levels.

"Blood glucose: The main sugar that the body makes from food and the body's main source of energy; cells cannot use glucose without the help of insulin. (Also called blood sugar.)

"Metabolic syndrome: Cluster of conditions (also known as syndrome X) that increase the risk of heart disease, classified by three or more of the following: abdominal obesity, high cholesterol or triglycerides, high blood pressure and high blood


"Prediabetes: Higher than normal fasting blood glucose level that is not yet high enough to be classified as diabetes.

Source: Joslin Diabetes Center at Harvard Medical School


"The National Indian Health Board:

"American Diabetes Association:

"Joslin Diabetes Center:

"U.S. Food and Drug Administration:

"Centers for Disease Control and Prevention:

"National Institute of Diabetes and Digestive and Kidney Diseases:

"The Physicians Committee for Responsible Medicine (Diabetes Resources):

"Juvenile Diabetes Research Foundation International: