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Diabetes Campaign Targets Native Americans, Alaska Natives

By Cheryl Simon Silver

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In response to the epidemic incidence of type 2 diabetes among Native Americans and Alaska Natives, the United States government this month launched a diabetes awareness campaign to encourage these populations to take steps to reduce the incidence and severity the disease.

In the United States, type 2 diabetes disproportionately affects African Americans, Hispanic and Latino Americans, and Native Americans. The campaign, sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), is part of a broad effort to target high risk groups, using promotional materials developed for each population.

American Indians and Alaska Natives are more than twice as likely to develop Type 2 diabetes as non-Hispanic whites of similar age, according to statistics compiled by the National Institutes of Health. Research in recent years indicates that many Native Americans are genetically predisposed to diabetes but also shows that changing one’s lifestyle can help prevent or delay the onset of the disease.

Over the last thirty years, researchers have compiled detailed health and genetic information about one group of Native Americans in particular—the Pima Indians of the Gila River Indian Community in Arizona.

This population has the highest known reported prevalence of diabetes anywhere in the world: half of the adults have type 2 diabetes. Data gathered from the longitudinal study have helped scientists confirm that obesity significantly heightens the risk of developing diabetes.

Nearly all of the adults with diabetes are overweight. The Pima Indians also tend to have low metabolisms, which, together with a sedentary lifestyle and high-fat diet acquired in recent years, may predispose individuals to being overweight.

For any population, the genetics of diabetes is almost certainly complex, with a number of genes contributing something to the overall risk. As with so many common diseases, any hope of finding a single gene responsible for susceptibility to diabetes gave way long ago to a more realistic approach that presumes genetic complexity.

Some of the susceptibility genes for diabetes are likely to be specific to certain populations, while others may be more “universal,” or common to multiple ethnic groups, says Leslie J. Baier, a researcher with NIDDK in Phoenix, Arizona.

In recent months, her group and their collaborators have identified regions of two human chromosomes that may contain susceptibility genes among several populations, including a group in Finland, the Amish, and the Pima Indians. Although the genes, if they exist, have yet to be found, the researchers are encouraged by the fact that the same regions were identified in the different groups.

Studies of two groups of Pima Indians—one in Arizona the other in Mexico—support the idea that individuals can lower their risk by changing their lifestyles, despite their genetic background.

The Pima Indians of Mexico, who are genetically similar to the Pima Indians of Arizona, have a more active lifestyle and a low-fat, lower calorie diet. They also have a much lower incidence of diabetes than their relatives to the north.

The new campaign by NIDDK notes that moderate exercise for 30 minutes five times a week, eating less, and healthier food choices can go a long way toward preventing or fending off the disease.

Still, many Native Americans have fatalistic attitudes about developing diabetes because so many of their family members and friends have it, according to Tom John, Director of the Chickasaw Nation Health System’s Diabetes Care Center in Ada, Oklahoma.

“They think it’s not a question of whether they’ll get diabetes, but when,” John says. “We’re showing them that it’s not necessarily true that they’ll get diabetes, or that, if they do, the disease will progress to the end stage.”

Leslie J. Baier and Robert L. Hanson. Genetic Studies of the Etiology of Type 2 Diabetes in Pima Indians: Hunting for Pieces to a Complicated Puzzle. Diabetes 53, 1181-1186 (May 2004).

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