We are the Tulalip (pronounced Tuh’lay-lup) Tribes of Washington State. Our tribal population is 5100 with more than half of our members residing on the 22,000-acre Tulalip Indian Reservation. Our health clinic facility is located on the reservation situated on the shores of Tulalip Bay, a historical site of the Indian Boarding School, with a farm and old marina. It is with respect that I mention this location since our health clinic and our SDPI funded gardens, greenhouse and walking trail are located on sacred ancestral grounds. We consider this a privilege to share knowledge and valuable experiences with our young and old on the value of our native food systems of the Pacific Northwest and the garden foods grown on this land. Our diabetes team members are people who understand and value the historical significance of our work environment and respect the community we serve.
Currently, we have 236 patients who rely on our coordinated team approach to diabetes care and prevention. Our diabetes team consists of multi-specialty providers and supporting staff who provide team-based patient education, community outreach, care coordination, tracking of health outcomes, and assisting with offsite access to healthcare specialties and case management for our patient registry. Our patients have access to primary care team, diabetes management specialist, dental, nutrition, podiatry, optometry, physical therapy, and alternative medicine such as massage therapy, certified herbalist and acupuncture within the clinic.
In addition to our diabetes registry of patients, we have a pre-diabetes registry of 250 patients. Our Prevention Team provides community outreach, prevention education to all age ranges, garden and farm events and organic food distribution. The prevention team members are also certified Kidney Health coaches and Diabetes Prevention Lifestyle coaches. We appreciate the ongoing support from our elders and attribute much of our success to them.
Our team decided on Kidney Disease Screening for our best practice choices for the 2023 grant cycle. This decision was made after careful reviewing our diabetes audit outcome reports for the last couple years to identify this as one of our areas needing improvement. There were many patients from our diabetes registry that did not have urine albumin/creatinine ratio (UACR) and/or estimated glomerular filtration rate (eGFR) screening in 2020 and 2021. We are also concerned for those currently living with kidney disease. Our level of intensity was determined to be medium to high. We believe in our team’s ability to be successful in completing this best practice and prevent or delay progression of kidney disease within our patients living with diabetes.
According to CDC 2022 report, 1 in 3 patients with diabetes have chronic kidney disease. Historically, kidney failure from diabetes among our indigenous people ranked higher than any other ethnicity. Our diabetes team have resources and are equipped to make a difference for the Tulalip community. Routine screening is the first step towards increasing awareness of this often-preventable disease. Our team will provide education on kidney health, promote healthy eating and exercise, prescribe kidney protection medications, and collaborate care with Puget Sound Kidney Center for ongoing support for patients living with kidney disease.
In 2017, CDC reported medical costs for kidney failure from diabetes treatment amounted to $86,400 per person. Kidney failure increases risk for other health problems, poses emotional and financial challenges for patients and their families. Therefore, our team decided to make kidney disease screening as our best practice for the next three years. This best practice will promote early detection and initiation of treatment to prevent kidney failure. With funding assistance from SDPI, we can achieve our goal of preventing this disabling disease and make an impact in the health of our indigenous community.