#### ![](media/image1.png){width="0.21875in" height="9.375in"} DIABETES

+-----------------------------------------------------------------------+
| **ISSUE**\                                                            |
| American Indians and Alaska Natives have the highest rates of type 2  |
| diabetes in the U.S. Diabetes is traditionally a disease of older     |
| people but, alarmingly, diabetes is being diagnosed at young ages in  |
| Indian communities. Prevention of diabetes and optimal management of  |
| diabetes to prevent its complications are urgent priorities.          |
|                                                                       |
| ![](media/image2.jpeg){width="4.0in"                                  |
| height="2.7555555555555555in"}**BACKGROUND**\                         |
| The IHS Division of Diabetes Treatment and Prevention (DDTP) has      |
| received national and international recognition as a leader in the    |
| area of diabetes quality improvement, including developing and        |
| monitoring systems of diabetes clinical care through its *Annual IHS  |
| Diabetes Care and Outcomes Audit* and creating diabetes surveillance  |
| systems for tracking diabetes prevalence and complications.           |
| Publications documenting IHS DDTP program's ability to improve care   |
| with low tech, low cost approaches have been numerous. However, the   |
| costs of providing quality diabetes care are extremely high.          |
| Estimates from the American Diabetes Association suggest that the     |
| average cost of diabetes care is over \$13,000 per patient per year,  |
| much of this due to the costs of pharmaceuticals. Yet the IHS per     |
| capita personal health care expenditure for American Indian and       |
| Alaska Native patients is \$2133. Thus, in the past the limited       |
| resources available for diabetes care in the Indian health system     |
| were mostly devoted to the clinical care of diabetes and prevention   |
| of its complications, rather than to less well scientifically proven  |
| methods for primary prevention of diabetes in those without the       |
| disease.                                                              |
|                                                                       |
| # SITUATION                                                           |
|                                                                       |
| The Balanced Budget Act of 1997 provided \$150 million over 5 years   |
| for "the prevention and treatment of diabetes in American Indians and |
| Alaska Natives." The funds were reauthorized for an additional 5      |
| years, fiscal years 2004-2008, at \$150 million per year. Two thirds  |
| of these tribal and urban Indian health grant programs focus at least |
| part of their efforts on primary prevention of diabetes, since the    |
| publication of new studies showing that diabetes can be prevented. As |
| part of this effort, the IHS established a quantitative and           |
| qualitative tracking system to monitor these efforts.                 |
| Additionally, 66 new grantees are part of a Targeted Demonstration    |
| Project that was launched in November 2004.  Thirty-six of these      |
| grantees are focusing on primary prevention of type 2 diabetes; the   |
| other 30 are focused on the reduction of cardiovascular risk in those |
| already diagnosed with type 2 diabetes. The implementation of these   |
| grants programs and complicated monitoring and evaluative activities  |
| of diabetes prevention and treatment efforts represent an increased   |
| investment in program infrastructure.                                 |
|                                                                       |
| #                                                                     |
|                                                                       |
| # OPTIONS/PLANS                                                       |
|                                                                       |
| The IHS Division of Diabetes continues to strengthen the IHS diabetes |
| infrastructure at the Headquarters and Area office levels to maintain |
| and improve diabetes surveillance, technical assistance, provider     |
| networks, and clinical monitoring. In addition, the Area Diabetes     |
| Consultants provide technical support to diabetes programs in their   |
| respective Areas by supporting culturally sensitive and focused       |
| prevention and treatment programs. A rigorous evaluation model for    |
| the Targeted Demonstration Project grantees has also been developed.  |
|                                                                       |
| **ADDITIONAL INFORMATION**                                            |
|                                                                       |
| For referral to the appropriate spokesperson, contact the IHS Public  |
| Affairs Staff at 301-443-3593.                                        |
+-----------------------------------------------------------------------+