Across America diabetes rates are exploding. A recent piece in The Washington Post put it this way: “Diabetes has reached epidemic proportions in the U.S., due to sugary diets and the lack of exercise. If current disease rates continue, one in three Americans will have diabetes by 2050. Over time, the condition can lead to kidney failure, limb amputations and blindness, among other complications.”
The post linked to a blogger, The Data Dude, and a chart that shows diabetes rates increasing in all but a few counties across the nation, a total of 2,992 of counties. Only five counties had rates that stayed the same and only ten counties showed an actual decrease.
Here is the thing. Two of the 10 counties showing a decrease in diabetes rates are found on Indian reservations, Fort Peck, Montana, and Rosebud, South Dakota. According to the United States Centers for Disease Control and Prevention, the rate of growth for diabetes in Roosevelt County, Montana, dropped from 13.2 percent to 12.9 percent, a three-tenths decline from 2004 to 2012. And a similar decline occurred in Mellette County, South Dakota, where the rates declined from 13 percent to 12.7 percent.
If these two reservation communities are showing a decline, what do the numbers look like across Indian country?
Unfortunately the CDC and the Indian Health Service use different data because, of course, the county map is not ideal. The Indian Health Service reported that its data would not be comparable with the county data cited.
However — and this is important — IHS data does indicate a slowing in the rate of rise of the prevalence of diabetes in American Indian and Alaska Native people nationally. From 2001-2005, there was a relative increase in age-adjusted diabetes prevalence in American Indian and Alaska Native adults of 2.2 percent per year on average. Contrast that with the period between 2006 and 2013 where diabetes prevalence among the same population increased at a rate of 0.8 percent per year on average.
Another measurement of that trend comes from the United States Renal Data System. The data show that the incidence of end-stage renal disease due to diabetes in American Indian and Alaska Native people decreased by 43 percent between 2000 to 2011. Looking at the numbers another way, between 1995 and 2006, the incident rate of End Stage Renal Disease in American Indians and Alaska Natives with diabetes fell by 27.7 percent—a greater decline than for any other racial or ethnic group.
The IHS says: “This translates into far fewer American Indian and Alaska Native patients with diabetes starting dialysis. Also, obesity rates and diabetes prevalence in American Indian and Alaska Native youth have not increased since 2006.”
In Poplar, Montana, Tessie LeMere, diabetes coordinator for the Fort Peck Tribal Health Department, says a lot of the work is community focused. One important activity encouraging people to drink water instead of sugary soda. “We offer our water system. If you have your own jug, you can bring it in here and we’ll give you clean water. We do home visits. We do community screenings. The community screenings are a big thing because it’s not just for our patients, that’s for everybody just to get the awareness and prevention out there. We have wellness centers. We pay to those so our patients have access. We also have a dialysis program over at tribal health. That I think has brought the awareness more into reality.”
Perhaps that’s it. The success in Indian country of the diabetes program is about doing everything, reaching out to both patients and those who are at risk for the disease. Again the numbers tell a story. A generation ago, before the Special Diabetes Program for Indians, only about a third of all Indian Health patients had access to diabetes clinics; today that number exceeds two-thirds. And 94 percent of patients have access to diabetes clinical teams, three times more than in 1997. And nearly 100 percent — 99 percent according to IHS — of people in the IHS system have access to diabetes education (up from 36 percent in 1997).
We hear all the time about how bad things are in Indian country. The story of improving diabetes rates counters that narrative. It shows a lot of things: First, tribally designed programs work, government funding is important and lessons from Indian country can help the larger country treat its diabetes epidemic.