# ![](media/image1.png){width="3.8in" height="3.8in"}

# 

# **Breastfeeding as a** 

# 

# **Diabetes Prevention Initiative** 

# 

#  **at Phoenix Indian** 

# 

#  **Medical Center**

Type 2 Diabetes has reached epidemic proportions in American Indians and
Alaskan Natives

The growing burden of diabetes is felt throughout the world. However,
minorities have higher rates than the general population. American
Indians and Alaskan Natives (AIAN) in particular experience type 2
diabetes and its complications 4-6 times more often than the general
population.

In response to the epidemic of diabetes, the Phoenix Indian Medical
Center (PIMC), established its Diabetes Center of Excellence (DCOE) in
1998 with the goal of reducing the impact of diabetes among its clients.
PIMC is an Indian Health Service (I.H.S.) medical facility, serving
Native Americans in Arizona and parts of Nevada, New Mexico, Utah, and
California. PIMC consists of 134 bed hospital and extensive outpatient
clinics.

**Breastfeeding as a type 2 diabetes prevention intervention**

Breastfeeding was chosen by DCOE as one of the interventions to help
reduce the impact of diabetes after a study by the National Institutes
of Health (Pettitt, et al) suggested that people who were breastfed as
infants for at least 2 months were less likely to have diabetes as
adults than people who were fed formula.

![](media/image4.wmf)The mechanism of the protective benefit of
breastfeeding on type 2 diabetes is not known. One reason for the higher
risk of diabetes may be that formula feeding is associated with
childhood obesity. In a study of almost 10,000 Bavarian school aged
children, breastfeeding was associated with lower rates of obesity.

Because breastfeeding is an intervention that can be done for a fairly
short period of time, and yet have life-long benefits, it appears to be
an ideal primary prevention intervention. If real life experience
continues to confirm the benefit seen in these studies, then
breastfeeding may become an intervention against diabetes, similar to
early childhood immunizations for prevention of infectious disease.

**Designing a Breastfeeding Intervention for AIAN**

The DCOE began by evaluating breastfeeding practices and issues for PIMC
families. The following was learned:

-   Families tend to be slightly younger and have more children than the
    general population.

-   Misinformation and lack of effective problem solving were common
    barriers to successful breastfeeding.

-   A major enhancer to breastfeeding was that PIMC staff and patients
    both identified breastfeeding as a traditional and culturally
    appropriate food for their children.

With this knowledge, in October 1999 the Breastfeeding Intervention was
designed to provide:

-   Readily available breastfeeding support

-   Standardization of breastfeeding information and messages

-   Collaborative support with community and tribal services used by
    families

To achieve these objectives, the following were established:

-   "24-7" breastfeeding hotline

-   Daily breastfeeding consultant coverage for the maternity and
    pediatric floors, pediatric and Women's clinics, postpartum
    follow-up

-   Provide information about the obesity and diabetes risk reduction of
    breastfeeding during initial prenatal care visit

-   Weekly breastfeeding drop-in classes, coordinated with WIC so that
    their prenatal participants can attend

-   Breastfeeding classes -- offered as an evening monthly class

-   Standardization of breastfeeding support information used at PIMC

-   Staff in-services offered in multiple formats

-   Establishment of a breastfeeding registry to track patients and
    provide monthly incidence/duration rates

-   Monthly progress reports for staff regarding PIMC breastfeeding
    incidence and duration rates

-   Collaboration with Inter-Tribal Council of Arizona (ITCA), WIC and
    tribal clinics to encourage seamless coverage and uniform
    information

-   Establishment of policy for employees to breastfeed and designated
    private pumping area for use

**During the Breastfeeding Intervention's first year, the following has
been noted**:

-   Trendlines for breastfeeding initiation and 8 week duration rates
    indicate an increase of 5 and 10% respectively for all PIMC
    deliveries

-   The rate of mother/infants who start out breastfeeding and stop
    before 8 weeks has dropped from 30% to 25%

-   An observation first noted during planning assessments - as parity
    increases, incidence and duration of breastfeeding decreases -
    continued.

**Plans for the future include:**

-   Expand networking within communities to improve patient follow-up
    and provide technical support/information sharing

-   Initiate peer counseling, formalized support groups and increased
    networking

```{=html}
<!-- -->
```
-   Assessment of why and when our mothers begin using formula while
    breastfeeding, and why higher parity is associated with less
    successful breastfeeding

-   In collaboration with NIH, completion of video, \"Close to the
    Heart\" and supporting education materials that shares information
    about the diabetes risk reduction for benefits of breastfeeding for
    Native Americans. These materials will be available upon request by
    1/01/02, free of charge. Please call 1-877-868-9473,

The PIMC DCOE Breastfeeding Initiative is seeking to increase
breastfeeding and the awareness of breastfeeding's potential for
reducing obesity and the risk of type 2 diabetes. For more information
or to share ideas, please contact us at:

> Phoenix Indian Medical Center 602-263-1200 X1896
>
> Diabetes Center of Excellence or Breastfeeding Toll-Free Hotline
>
> 4212 N. 16^th^ Street 1-877-868-9473
>
> Phoenix, AZ 85016 Email: <Suzan.Murphy@pimc.ihs.gov>
>
> Attn: Sue Murphy