According to the Urban Indian Health Institute's Urban Diabetes Care & Outcomes Summary Report, Audit Years 2015–2019, type 2 diabetes is more prevalent in the AI/AN population than in any other race or ethnicity in the United States and is two times more prevalent among AI/AN than among non-Hispanic Whites. The top risk factors for type 2 diabetes among AI/AN population is weight and inactivity. In 2019, 42.2% of urban AI/AN patients with diabetes had an A1c level of 8.0% or greater, which is an increase from 2015. In 2019, nearly half (48.1%) of urban AI/AN patients with diabetes had a BMI of 30.0–39.9, which is considered obese, and almost a quarter (21.8%) were morbidly obese (BMI of 40+). Diabetes is a leading cause of chronic kidney disease, which can be tested for by assessing both estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (UACR). In 2019, 20.2% of patients did not have eGFR tested and 45.8% did not have UACR tested, which were both increases since 2015. Lifestyle changes such as diet and exercise can help to manage diabetes. In 2019 64.1% of urban AI/AN patients with diabetes received exercise education, which decreased significantly from 2015 (78.4%). Close to only a quarter of patients (24.7%) received nutrition education from a Registered Dietitian. Routine eye, feet, and dental exams can help with diabetes complications such as microvascular blood damage in the eyes, feet and mouth. In 2019 less than half of diabetes patients received an eye exam (36.8%) or a dental exam (29.8%).
The DIHFS SDPI Program will implement strategies to mediate the forementioned health disparities relating to diabetes. These include 1) Shared Medical Appointment Program: The SMA program is a 7-week diabetes education program that is certified by the Association of Diabetes Care and Education Specialists. The program curriculum consists of six in person or virtual classes followed by the seventh class which is the final celebration workshop. 2) Healthy Lifestyle Coaching: DIHFS' staffing capacity has grown to include a Healthy Lifestyle Coach (HLC) who holds certificates as a Certified Personal Trainer, Certified Strength and Conditioning Specialist, and Certified Health Coach. Patients can schedule individual physical training sessions with the HLC to help manage and prevent diabetes through physical activity. The HLC will conduct 1:1 personal training programming and group physical fitness classes. 3) Pharmacy 303 insulin titration program and medication management: Through our 340B pharmacy, our patients can access insulin and other diabetes treatment medications at low costs compared to other commercial pharmacies. Our pharmacists and student interns provide 303 insulin titration management, medication management, and diabetes treatment and prevention education to our patients. Patients can spend time with the pharmacy dept. discussing their medications and learning about how to prevent and manage their diabetes. The pharmacy will conduct 303 medication management with the diabetes patients and provide additional diabetes education as needed. 4) Nutrition Counseling: DIHFS' staffing capacity has grown to include a Registered Dietitian (RD). Patients can schedule individual 1:1 nutrition counseling visits with the RD. Nutrition counseling and weight management is provided through the RD where patients can learn more about what types of healthy foods to eat, utilize the My Native Plate program, and create a meal plan specific to their needs. We hope to
reach at least 210 individuals annually throughout the duration of the project.