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Trends in Diabetes Prevalence Among American Indian and Alaska Native Children, Adolescents, and Young Adults—1990-1998

This report is also provided in Portable Document Format [PDF–156 KB].

Diabetes has been emerging as a major public health concern among Native American communities in the United States for the past 40 years. The Pima Indians in Arizona currently have the highest recorded prevalence of diabetes in the world. On average, American Indian and Alaska Native adults are 2.6 times more likely to have diabetes than non-Hispanic whites of similar age. A new study by the Centers for Disease Control and Prevention (CDC) and the Indian Health Service (IHS) reveals dramatic increases among young American Indians and Alaska Natives and raises concerns about the impact of diabetes on future generations of Native Americans.

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Results

Between 1990 and 1998, the number of American Indian and Alaska Native children, adolescents, and adults aged 35 years and younger diagnosed with diabetes increased 71 percent from 4,534 to 7,736, a rate of about 9 in every 1,000 people in that age group in 1998.
Overall, the prevalence of diagnosed diabetes was higher among females aged 35 and younger than among males. Data show that in 1998, about 11 in every 1,000 women had diabetes compared with 8 of every 1,000 males. However, during the study period, the rate of increase among males jumped by 61 percent compared with 36 percent among females.
While the overall prevalence rate increased by 46 percent during the 8-year period, the largest increases were seen in adolescents aged 15-19 years; that is, 60 percent among females and 81 percent among males.
Diabetes rates among Native Americans vary widely within the seven geographic regions of the United States: Alaska, Great Lakes, Northern Plains, Pacific, Southeast, Southern Plains, and Southwest. The Southeast region had the highest prevalence rate of 34.9 per 1,000 among Native Americans aged 35 and younger in 1998.
Between 1990 and 1998, increases were noted in each region. Rates of increase ranged from 152 percent in the Alaska region to 6 percent in the Pacific region.
Although the prevalence of diagnosed diabetes among American Indian and Alaska Native children younger than 15 years did not increase nationally, increases in this age group were seen in three regions: Great Lakes, 27 percent; Southeast, 38 percent; and Alaska 114 percent.

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Key Conclusions

Increased diabetes among women of childbearing age poses serious concerns. Their diabetes may contribute to a cycle of diabetes during pregnancy, leading to the early onset of the disease among their children. Diabetes is also a major cause of birth defects and perinatal deaths.
The increase in diabetes among young Alaska Natives was twice that of all Alaska Natives during a similar time period and may signal the acceleration of a diabetes epidemic in that community.
Young persons with diabetes may face unique challenges in diabetes care and management, such as lack of symptoms, absence of family support, and denial of the disease.
To successfully manage their disease, children and adolescents need an environment that facilitates the development of adequate coping skills to adapt to life with diabetes and the motivation to adopt healthy eating habits.
Most cases of diabetes among Native Americans are type 2, the most common form of the disease, and is associated with modifiable risk factors such as obesity and inactivity. Thus, prevention has become an increasingly important goal for American Indian and Alaska Native communities.

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Prevention Efforts

The 1997 Balanced Budget Act provided $150 million in grants to IHS over 5 years for programs to "prevent and treat" diabetes among American Indians and Alaska Natives. As a result, more than 300 new programs have been established since then.
American Indian communities have developed school-based programs, such as Pathways and Quest, to increase physical activity, improve diet, and reduce obesity among children.
In 1998, CDC funded the National Diabetes Wellness Program in Gallup, New Mexico, to promote diabetes prevention and control among the Navajo Nation, Zuni Pueblo, and others.

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