SDPI Diabetes Best Practices for FY 2016

Diabetes Prevention Education helps reduce the risk of developing diabetes and its complications.

As America has been made aware, diabetes has become epidemic among American Indians. The onset of diabetes and pre-diabetes conditions are now occurring at younger and younger ages. We have spent years working at the "awareness" of diabetes and prevention of diabetic complication. Now tribal leaders are becoming more aware of the new "epidemic" and many of the leaders are considering diabetes to be the number one health problem for their communities.

The Special Diabetes Program for Indians Community directed for Colville Confederated Tribes Project.

Looking at public health programs in urban communities and the model they are fashioned after, one of the most important functions is the screening of people who are at risk for certain diseases. Diabetes is certainly a disease that warrants a screening project, because diabetes causes a high burden of disease; it is detectable by testing sometimes years before symptoms occur, and especially before the disease is irreversibly established. The screening tests for pre-diabetes are very reliable and available, and, diabetes, can be prevented by lifestyle changes.

Given the above circumstances, the diabetes program of the Colville Confederated Tribes proposes to determine the risk/prevalence of diabetes among the Native youth.

The Goal
is to find the number of youth and adolescents living on or near the Colville Reservation who have metabolic syndrome or insulin resistance, who are at risk for diabetes ;that will result in intervening education for lifestyle changes with the families of said youth.

The design/method will be a school-based screening program at 7 elementary, middle and high schools on or near the Colville Reservation. Children are screened from 4th grade through 12th grade by implementing a systematic screening process that collects demographic information, biometric measures, activity, family history, and medical markers for diabetes, impaired glucose tolerance, impaired fasting glucose, and insulin resistance syndrome.

All youth testing positive for the above markers, and their families, will receive an invitation for lifestyle changing classes. Some of these might include: exercise therapy, nutrition and traditional foods education, healthy shopping and cooking, diabetes basics, traditional activities, or medications for diabetes. Case management follow-up activities will ensue with the help of our collaborators.

Required key measure
Number and percent of individuals in your Target group who receive education on any diabetes topic (includes nutrition education, physical activity education, and any other diabetes education), either in a group or individual setting.

Target Group Guidance
Select from adults and/or youth with diabetes and/or at risk for developing diabetes.
Many families use outlying clinics, but I.H.S Q-man shows local demographic of 3,381 youth under 20 yr. Estimation of numbers in 7 schools on or close to reservation is ~~3,000. All children will be invited to screen, so not to separate native children from group. In addition other target demographic will be 800 adults with in a geographic area. All participants that are screened  will receive a printout of results. The participant/family will receive  letters of screening results with explanation if preliminary screening results fall within parameter of at risk for pre-diabetes/ diabetes. Once identified the native families will be invited to the interventions activities.

 Children will be screened to the following parameters:

  • Capillary blood glucose (by glucometer) -- Fasting = < 100 mg/dl, Random = < 140 mg/dl

  • Capillary HbA1c (by DCA 2000) -- Fasting = < 5.7%, Random = < 6.3 %

  • Using the Inbody T 270 to calculate obesity analysis that determine risk factors by BMI category--

  • Normal (BMI) < 25.0), Overweight (BMI 25.0 to 29.9) Obese (BMI 30.0 or above)

All parents will receive letters from the program with the results and information applied to that youth. All youth testing outside of the parameters will be offered participation in a lifestyle intervention class. Note: classes will be open to all Colville families and youth; however, we will make a special effort to encourage kids with pre-diabetes to attend.

Our Resources
The program currently has three (3) Health educators with knowledge of many different aspects of diabetes treatment and prevention. The program additionally, has one (1) Registered Dietitian/medical adviser, along with two (2) administrative support staff. We are currently preparing to hire addition staff with the new award acceptance from the tribe with the additional of one (1) new grant development specialist. The grant development specialist will help the diabetes education manager research, write and incorporate new channels of grant funding toward program sustainment.