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Special Diabetes Legislation Renewed at Low Level

WASHINGTON – Congress has voted to renew the Special Diabetes Program for Indians until 2013. The reauthorization was approved Dec. 9 after the House voted in the affirmative. It was passed by unanimous consent in the Senate the day before.

The measure offers $150 million in funding per year to the program – a number IHS Director Yvette Roubideaux has previously argued is much too small due to the alarming rates of diabetes in Indian country.

Roubideaux has long been a personal champion of the program. She once served as the co-director of the Coordinating Center for the Special Diabetes Program for Indians Competitive Demonstration Projects, a program implementing diabetes prevention and cardiovascular disease prevention activities in several Indian communities.

Before serving in the Obama administration, she conducted extensive research on American Indian health issues, with a special focus on diabetes in American Indian and Alaska Native communities and American Indian health policy.

Roubideaux wrote in a 2007 Indian Country Today column about her belief in the importance of supporting the program.

“Most people know about all the new diabetes prevention activities in their communities – fun runs, cooking classes, health fairs or new exercise equipment at the wellness or community centers,” she wrote.

“Some notice they are getting newer medications, meters to check their blood glucose and a lot more attention in the clinic.

“But few associate these new activities and services with the actual name of the congressional funding that led to their creation: The Special Diabetes Program for Indians.”

When the program was reauthorized through Sept. 2011, she said in an interview with ICT that “[t]he reauthorization of SDPI is critical for us to continue to be able to offer all of the progress that’s been made since the funding started 10 years ago.”

She noted at the time that the program was still being funded at the same level – $150 million – as when it was reauthorized in 2002. The current reauthorization continues that small amount per year, despite rising diabetes rates.

“It’s clearly not enough money,” Roubideaux said at the time. “And the problem of diabetes isn’t solved very easily.”

Meanwhile, Roubideaux has noted that the rate of heart disease in American Indians has grown rapidly as Indians are living longer, and the rates of diabetes and obesity have skyrocketed. Plus, federal research indicates that Native Americans suffer from diabetes at more than twice the rate of the general population in the U.S. In some tribal communities the rate of diabetes has reached over 60 percent.

Sen. Byron Dorgan, D-N.D., introduced bipartisan legislation to reauthorize the program in March.

“Reauthorization of the Special Diabetes Program is critically important in our nation’s growing effort to combat this devastating disease,” Dorgan said after the passage. “The Special Diabetes Program is a smart federal investment – leading to important discoveries and clinical advances as well as providing crucial and often life-saving programs to Native Americans.”

The program provides diabetes treatment and prevention services to Native Americans across the country, and it provides funding for research on Type 1 diabetes at the National Institutes of Health.

Over the years, the program’s funding has supported numerous grants to IHS and tribal and urban Indian health organizations for diabetes prevention and treatment programs. SDPI funds go directly to IHS and then are distributed based on recommendations of the agency’s director.

The American Diabetes Association, the Juvenile Diabetes Research Foundation, the National Indian Health Board and many Native groups have long been proponents of the program.

Hundreds of community-directed diabetes-focused efforts have been funded as a result of SDPI.

Indian health experts point to specific developments involving better diabetes outcomes they say are likely attributable to SDPI funding. For instance, a report by the Centers for Disease Control and Prevention in 2007 indicated that in Native populations, new cases of dialysis due to diabetes have actually been decreasing since 1996. Also, 93 percent of Indian communities served by SDPI now report that they offer primary prevention of diabetes services to children and youth, versus less than 10 percent in 1996 before SDPI was implemented.

Other government-sponsored studies have highlighted results of the program’s prevention efforts, including increased physical activity programs in schools, wellness programs and increased nutrition education.

Despite the successes thus far, American Indians and Alaska Natives still have the highest age-adjusted prevalence of diabetes among all U.S. racial and ethnic groups, according to research by the CDC.