The Diabetes Team at Indian Health Council, Inc has recognized chronic kidney disease (CKD) as a disturbingly prevalent long-term adverse effect of uncontrolled diabetes within our local clinic population. Despite previous attempts to positively influence and educate our diabetic patients toward the improvement of their glycemic control through lifestyle modification and proper medical management, our current rate of development of diabetic kidney disease is > 30%. The funds from the Special Diabetes Project for Indians grant program will help subsidize our efforts to focus on CKD education and prevention through individual case management and consultation, home visitation, CKD awareness events within the community, monthly diabetes clinics at our two clinic sites, quarterly Smart Kidney classes (in conjunction with our local dialysis center) as well as two events annually to showcase diabetes and CKD awareness. Outreach activities will include, but not be limited to, monthly diabetes education classes to review the basics of the condition, semi-annual grocery store tours to demonstrate healthy shopping habits and bimonthly cooking demonstrations posted on our social media channels to promote alternative methods to prepare meals for nutritional wellness. We are prioritizing collaboration with our outside nephrology partners in addressing the health literacy challenges in our community by having our local nephrologist provide didactic sessions on kidney care. We will focus on standardizing the implementation of chronic kidney disease screening through the collection of both blood for glomerular filtration rate (eGFR) measurement and urine for urine albumin to creatinine ratio (UACR) measurement and will quarterly monitor the percentage of patients who have received both screenings within the past year. Our goal is to reach 100% of our diabetic patients who are not current on these screenings as of the start of the grant. Ultimately our o
bjective is to see our diabetic population thrive and not succumb to the renal complications of the disease. This plan will continue with expansion of services as is appropriate and possible annually over the 5-year grant cycle.