Western Tribal Diabetes Project

Northwest Portland Area Indian Health Board

Indian Leadership for Indian Health

Western Tribal Diabetes Project

Kerri LopezProject Director

Organizational Chart

Northwest Diabetes Project NTCCP& W H PP

National Diabetes Project

W T D P & N T C C PK e rr i L o p e z,

D ire c tor

N o r th w e st T rib a l E p id e m o lo g y C e n terV ic to r ia W arre n -M e a rs

D ire c tor

N P A IH BJ o e F in kb o n n e r,

E x e cu tiv e D ire c tor

N o r th w e st P or tla n d A r e a In d ia n H e a lth B o a rdE x e c utiv e C o m m itte e M em b e rs

Staff & Funding

• Staff Kerri Lopez, Director Don Head, Project Specialist Erik Kakuska, Project Specialist Elizabeth Viles, Project Assistant

• 5% set-aside SDPI funding • National Contract

DMS training sessions Special projects Program evaluation tools

Diabetes register as a tool

• In RPMS (or EHR), a list of patients you want to track

• Patients are never added automatically – you get to do this Pulls information about diabetes care from

clinic database• Can be used for

case management (making sure individuals get care)

care management (looking at groups of patients together)

Diabetes (a refresher)

Northwest Portland Area Indian Health Board04/21/23 5

• The body does not produce enough insulin ~ or cannot use the insulin it makes

• Glucose (sugar) builds up in the blood and overflows into urine

+ =Glucose Insulin

Energy

Diabetes (a refresher)

04/21/23

The body loses its main source of fuel even though the blood contains large amounts of glucose

(like being thirsty in the middle of the ocean)

Type 1 diabetes

• Autoimmune disease that attacks the cells that produce insulin Body does not produce insulin Need to take insulin every

day to survive

• Typically diagnosed in children and young adults

• Comes on relatively suddenly

Only 5%- 10% of diabetes is Type 1

RISK FACTORS for Diabetes

• OBESITY/OVERWEIGHT• GENETICS/FAMILY HISTORY• ETHNICITY• GESTATIONAL DIABETES• IMPAIRED GLUCOSE

TOLERANCE/PRE-DIABETES• SMOKING

DIABETES RISK FACTORS

• Cost of diabetes in the United States, 2002

• Total (direct and indirect): $132 billion

• Direct medical costs: $92 billion• Indirect costs: $40 billion (disability,

work loss, premature mortality)These data are based on a study conducted by the Lewin Group, Inc., for the American Diabetes Association and are 2002 estimates of both the direct costs (cost of medical care and services) and indirect costs (costs of short-term and permanent disability and of premature death) attributable to diabetes. This study uses a specific cost-of-disease methodology to estimate the health care costs that are due to diabetes.

AMERICAN INDIANS/ALASKA NATIVES AND DIABETES

•American Indians and Alaska Natives are 2.4 times as likely to have diabetes as non-Hispanic whites - 3.3 million AI/AN 2007

•16.3 percent of American Indians and Alaska Natives aged 20 years or older who received care from the Indian Health Service (IHS) in 2007 had diagnosed diabetes

•Annual cost 13,243•7,140 diagnosed cases 2007 Portland Area

(National Diabetes Information Clearinghouse)

Diabetes complications

• Diabetic retinopathy

• Neuropathy• Cardiovascular

disease• Amputation• Renal (kidney)

failure

• Use your diabetes audit to target lifestyle interventions:BMITobacco UseBlood Sugar ControlDiabetes Education

• GPRA reports

What You Can Do To What You Can Do To Reduce ComplicationsReduce Complications

Good news!

• Diabetes is preventable!• You can screen for it!• The disease process can even be

(partly) reversed!• Healthy eating and regular

activity are key

PRE-DIABETES RISK FACTORS

• FAMILY HISTORY• HIGH BLOOD PRESSURE• HIGH TRIGLYCERIDE LEVELS• GESTATIONAL DIABETES• GIVING BIRTH TO A BABY MORE

THAN 9 POUNDS• OBESITY and OVERWEIGHT

How did we get here?

Adoption of a “westernized” high fat diet McDee’s vs. Subway (portion size)

• Access to quality foods, fresh fruits, and vegetables. Rural communities have no supermarkets, higher price…Commodities; often high in fat and calories.

• Less reliance on hunting and farming as occupations…sedentary occupations. ~

• Technological advances in society has hurt us all.• Access to facilities, consistent care.

Travel time, few wellness centers, new providers • Sense of Hopelessness/Depression

~ I’ve got diabetes…OK

Portland Area overweight rates have

remained consistently elevated and above

the national IHS rates. These overweight

rates (87%) are considerably higher than

the current US average (66%).

*2003-2004 National Health and Nutrition Examination Survey, percentage of U.S. adults either overweight or obese.

Audit Results for Patients with Diabetes Portland Area 2005-2011

HSR Portland Area 2011

Diabetes Prevention Diabetes Prevention StudyStudy

Middle-aged people with pre-diabetesMiddle-aged people with pre-diabetes 171 Native Americans171 Native Americans OverweightOverweight Motivational counselingMotivational counseling Reducing fat and saturated fatReducing fat and saturated fat Moderate weight lossModerate weight loss Increased physical activity (walking)Increased physical activity (walking)

Diabetes Prevention Diabetes Prevention StudyStudy

Risk of diabetes Risk of diabetes

reduced by 58% with reduced by 58% with

a 7% weight lossa 7% weight loss

0%

5%

10%

15%

20%

25%

Wow!!Wow!!

Obesity - Obesity - PREMATURE PREMATURE DEATHDEATH

• The risk of death rises with The risk of death rises with increasing weight.increasing weight.

Obesity can cut up to 20 years Obesity can cut up to 20 years offoff

a person's life.a person's life.

Obesity - Obesity - HEART HEART DISEASEDISEASE

• Heart diseaseHeart disease is increased .is increased .• High blood pressureHigh blood pressure is twice as is twice as

common.common.• High cholesterolHigh cholesterol is increased.is increased.

Obesity - Obesity - DIABETESDIABETES

• 11 to 18 pounds11 to 18 pounds increases increases diabetes risk by 100%. diabetes risk by 100%.

• Over 80% of people with Over 80% of people with diabetes are overweight or diabetes are overweight or obese.obese.

Obesity - Obesity - CANCERCANCER

• Increased risk of cancer.Increased risk of cancer. Lining of the uterusLining of the uterus ColonColon Gall bladderGall bladder ProstateProstate KidneyKidney

• Women can double their risk of Women can double their risk of postmenopausal breast cancer.postmenopausal breast cancer.

CC

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What About The What About The Kids?Kids?


• 1 in 3 are overweight1 in 3 are overweight

• 1 in 6 are obese1 in 6 are obese

• + 400% obesity since 1975+ 400% obesity since 1975

• Obesity rates much higher in Obesity rates much higher in Native kidsNative kids


• School PE budgets slashedSchool PE budgets slashed• Most kids donMost kids don’’t walk to schoolt walk to school• Most kids are not in after-school Most kids are not in after-school

sportssports• Electronic babysittingElectronic babysitting• Working moms=fast food dinnersWorking moms=fast food dinners• Family R&R is usually inactiveFamily R&R is usually inactive

Overweight Kids in SocietyOverweight Kids in Society

TV & ObesityTV & Obesity

43%43%

TeensTeens

WatcWatchh

>2hr>2hr

TVTV

dayday

TV & ObesityTV & Obesity

• Most kids ages 2-18 watch Most kids ages 2-18 watch a total of a total of > 5 hours/day> 5 hours/day of of electronic mediaelectronic media

• 1 in 4 kids get no school 1 in 4 kids get no school PE at allPE at all

• Teen obesity may Teen obesity may aggravate eating aggravate eating disorders and emotional disorders and emotional problems.problems.

Obesity - Obesity - CHILDREN AND CHILDREN AND ADOLESCENTSADOLESCENTS

• Increased risk for:Increased risk for: high cholesterol & blood high cholesterol & blood

pressurepressure heart disease & diabetesheart disease & diabetes asthmaasthma joint problemsjoint problems adult obesityadult obesity Children perceive their own social Children perceive their own social

discrimination because of obesitydiscrimination because of obesity

Metabolic Syndrome in Metabolic Syndrome in KidsKids

• Nearly 1 million U.S. teenagersNearly 1 million U.S. teenagers

““……almost three out of every 10 is almost three out of every 10 is like a ticking time bomb for heart like a ticking time bomb for heart disease because they have disease because they have metabolic syndromemetabolic syndrome.. ””

Michael Weitzman MDMichael Weitzman MD

Director of the American AcademyDirector of the American Academy

of Pediatrics' Center for Child of Pediatrics' Center for Child Health ResearchHealth Research

Overweight in American Overweight in American Indian Kids Indian Kids

•200-300% more 200-300% more common than common than non-Natives.non-Natives.

•5 in 10 Native 5 in 10 Native kids are kids are

overweight or overweight or obese.obese.

The Future ?The Future ?

• ““……these children are atthese children are at very very high risk for serious problems high risk for serious problems later onlater on, and if we don't , and if we don't change their status,change their status,

• ……these are going to be people these are going to be people withwith diabetes in their twenties diabetes in their twenties or thirties and their first heart or thirties and their first heart attack in their forties."attack in their forties."

CDC directorCDC director

Dr. Julie GerberdingDr. Julie Gerberding.

Getting A Grip On Getting A Grip On ObesityObesity

• WhatWhat’’s The Problem?s The Problem?

• WhatWhat’’s It Got To Do With s It Got To Do With Me?Me?

• What Can I Do About It?What Can I Do About It?

What You Can What You Can DoDo

• Walking at Walking at least 1 hour least 1 hour for most days for most days of the week of the week can reduce can reduce risk of risk of developing developing diabetes.diabetes.


• Weight loss is Weight loss is the keythe key

• Drastic weight Drastic weight reductions & reductions & severe diets are severe diets are not needed to not needed to reduce risk and reduce risk and improve healthimprove health


• Keeping kids fit is Keeping kids fit is not rocket science.not rocket science.

• Smaller food portions. Smaller food portions. Healthier food choices.Healthier food choices.

• Make Make ‘‘em walk.em walk.• Chores of activity.Chores of activity.• Limit all TV/PC/electronic Limit all TV/PC/electronic

media to one hr/day.media to one hr/day.• Active family rec Active family rec

activities.activities.

• Lead by example.Lead by example.


• Diabetes, metabolic syndrome, Diabetes, metabolic syndrome, heart disease and stroke risks heart disease and stroke risks can all be improved by these can all be improved by these small reductions in body weight.small reductions in body weight.T r e a t m e n t & P r e v e n t i o nT r e a t m e n t & P r e v e n t i o n

•• E a t B e t t e rE a t B e t t e r

•• W a l kW a l k

•• L o s e W e i g h tL o s e W e i g h t

• Dr. Daniel Marks - curriculum• Tips for balancing energy everyday• Good food that’s good for you• Ways to get the family moving• Ways to wean the screen• How to maintain a healthy weight

What We Can Do

Ten tips

• Choose to move

• Cut down on screen time

• Steer clear of sugary drinks

• Limit Fast Food

• Respect your appetite

• Don’t use food as a reward

• Eat Breakfast

• Choose more fruits and vegetables

• Make fitness a family project

• Stay Positive

• Healthy weight for life

• Youth and type 2 Diabetes

• School Health and Diabetes

• http://www.ihs.gov/MedicalPrograms/Diabetes/index.cfm?module=toolsBestPractices• http://www.ihs.gov/healthyweight/

IHS Best Practices

• Michelle Obama’s kickoff• AI/AN youth obesity task force• School Health, head start, day care• 5 easy steps – • Action plan• http://www.letsmove.gov/blog/2010/03/09/combating-childhood-obesity-indian-

country

IHS Let’s move in Indian Country

• Staying on the Active Path• Modified Indian Games

Non competitive – youthAdults and elders

• Strength and flexibility• Teaching cues and set up• http://www.ihs.gov/hpdp/index.cfm?module=PAK

IHS Physical Activity Kit


• Life in balance• K-12 AI/AN Students• Increase

understanding of health and diabetes

• Increase understanding of science and health

• A balancing act• All life is connected• Exploring the food

groups• Balancing the

bodies needs• Harvesting our

mother earth

Diabetes Education in Tribal Schools(DETS)


http://www3.niddk.nih.gov/fund/other/dets/

• Life in balance• K-12 AI/AN Students• Increase

understanding of health and diabetes

• Increase understanding of science and health

• A balancing act• All life is connected• Exploring the food

groups• Balancing the

bodies needs• Harvesting our

mother earth

Diabetes Education in Tribal Schools(DETS)


http://www3.niddk.nih.gov/fund/other/dets/

• 7 steps to success for teensMales and femaleTweens

• “Train the trainer model”

• http://www.womenshealth.gov/BodyWorks/toolkit/

Body Works

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• Sports, Play and Active Recreation for Kids (SPARK) curricula for early childhood, elementary, middle school and high school age youth

Adults must receive training on how to provide the curricula in their community.

• http://www.sparkpe.org/about.jsp

SPARK


• School curriculum Preschool K-8

• Change attitude and behavior

healthy eating physical activity Nutrition

• http://www.flaghouse.com/Athletic/CATCH/-Curriculum-PN=1&navlink=true overview

• http://www.flaghouse.com/CatchPE.asp?srccode=901629&gclid=CKql0-6j0qACFV455wodrEjw1A resources

Catch works

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• School curriculum 3-5 and 6-8

• Food choices Nutrition, healthy choices, food pyramid

• Physical activity - goals Develop and maintain physical activity Prevention of obesity and heart disease Aerobic, endurance, composition, flexibility,

muscle and self image

www.acefitness.org

Operation Fit Kids ACE curriculum

Northwest Portland Area Indian Health Board 5404/21/23

• We can (CDC) http://www.cdc.gov/diabetes/

• Lean works http://www.cdc.gov/leanworks/

• Small steps – big reward (NDEP) http://ndep.nih.gov/publications/

PublicationDetail.aspx?PubId=11 http://ndep.nih.gov/

Other curriculums - Adults


• Short cut and reference manual

• Health Status Report• Tribal diabetes comparison

report• Tribal diabetes trends report• NW Diabetes Aggregate

Report• Diabetes Screening Toolkit

WTDP Tools and Resources

• Nike Native FitnessJuly 30th & 31st Nike TWC Sports Fitness Aerobics Boot camp

• DMS trainingsJune 4th-6th

Other trainings – Youth Focus


Motivational InterviewingDiabetes resourcesBest practicesCurriculums

Northwest Tribes Meet the Challenge

• 10,000 STEPS• Youth screening in

schools• Aerobics/Water • Aerobics Video• Mile Moccasin Club• Yoga• Fitness

centers/personal trainers

• Golf tournaments• Community Gardens• Biggest Loser• Health Fairs• Walk to Smithsonian

• Cooking classes/healthy eating• Pre-diabetes Screening• Just Move It• Youth and Adult Diabetes Camps• Tribal Diabetes Conferences• Lifestyle Intervention Classes

Documents

Western Tribal Diabetes Project