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S. HRG. 111–732 

A WAY OUT OF THE DIABETES CRISIS IN INDIAN 

COUNTRY AND BEYOND 

HEARING 

BEFORE THE

COMMITTEE ON INDIAN AFFAIRS 

UNITED STATES SENATE 

ONE HUNDRED ELEVENTH CONGRESS 

SECOND SESSION 

JUNE 30, 2010 

Printed for the use of the Committee on Indian Affairs 

( 

(II) 

COMMITTEE ON INDIAN AFFAIRS 

BYRON L. DORGAN, North Dakota, Chairman 

JOHN BARRASSO, Wyoming, Vice Chairman 

DANIEL K. INOUYE, Hawaii 

KENT CONRAD, North Dakota 

DANIEL K. AKAKA, Hawaii 

TIM JOHNSON, South Dakota 

MARIA CANTWELL, Washington 

JON TESTER, Montana 

TOM UDALL, New Mexico 

AL FRANKEN, Minnesota 

JOHN MCCAIN, Arizona 

LISA MURKOWSKI, Alaska 

TOM COBURN, M.D., Oklahoma 

MIKE CRAPO, Idaho 

MIKE JOHANNS, Nebraska 

ALLISON C. BINNEY, Majority Staff Director and Chief Counsel 

DAVID A. MULLON JR., Minority Staff Director and Chief Counsel 

(III) 

C O N T E N T S 

Page 

Hearing held on June 30, 2010 ............................................................................... 1 

Statement of Senator Dorgan ................................................................................. 1 

Statement of Senator Johnson ................................................................................ 5 

Statement of Senator Tester ................................................................................... 5 

WITNESSES

Baker, Caitlin, Member, Muscogee Creek Nation ................................................. 36 

Prepared statement with attachments ........................................................... 38 

Fradkin, Judith E., M.D., Director, Division of Diabetes, Endocrinology and 

Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, U.S. Department of Health 

and Human Services ............................................................................................ 7 

Prepared statement .......................................................................................... 10 

Hall, Jr., Gary, Three-time Olympian Swimmer, Ten-time Olympic Medalist .. 28 

Prepared statement .......................................................................................... 30 

McCabe, Melvina, M.D., President, Association of American Indian Physicians ...................................................................................................................... 31 

Prepared statement .......................................................................................... 34 

Studi, Wes, Professional Actor; Member, Cherokee Nation ................................. 24 

Prepared statement .......................................................................................... 26 

ADDITIONAL TESTIMONY

Burger, Isabel ‘‘Izzy’’, Member, Little River Band of Ottawa Indians ................ 57 

APPENDIX

National Indian Health Board, prepared statement ............................................. 63 

The Special Diabetes Programs—Stories of Hope and Progress ......................... 67 

(1) 

A WAY OUT OF THE DIABETES CRISIS IN 

INDIAN COUNTRY AND BEYOND 

WEDNESDAY, JUNE 30, 2010 

U.S. SENATE, 

COMMITTEE ON INDIAN AFFAIRS, 

Washington, DC. 

The Committee met, pursuant to notice, at 9:40 a.m. in room 

628, Dirksen Senate Office Building, Hon. Byron L. Dorgan, 

Chairman of the Committee, presiding. 

OPENING STATEMENT OF HON. BYRON L. DORGAN, 

U.S. SENATOR FROM NORTH DAKOTA 

The CHAIRMAN. We are going to now turn to the Oversight Hearing on the issue of diabetes, which is a crisis in Indian Country. 

I am going to ask the witnesses for the hearing to please take 

their position at the table. 

I am going to ask, if I might, the permission of Dr. Judith 

Fradkin, M.D., the Director, Division of Diabetes, Endocrinology 

and Metabolic Diseases at the National Institutes of Diabetes and 

Digestive and Kidney Diseases, NIH, if you will take your seat at 

the table. 

I would like to ask your permission if I might bring the other 

four witnesses to the table at the same time and we will hear from 

Dr. Fradkin first. Let me ask Mr. Wes Studi to come to the table, 

Mr. Gary Hall, Dr. Melvina McCabe and Ms. Caitlin Baker. 

Let me thank all of you for taking the time to travel here and 

to come to a hearing on what I think is a very important subject. 

This is not the first time that we have had hearings on the subject 

of diabetes, particularly as it affects American Indians. 

The high prevalence of diabetes among Native Americans and 

across the United States is not something we can ignore. But, if 

you take a look at the prevalence of diabetes on Indian reservations, it is extraordinary. 

I recall, over two decades ago, flying one morning into the Three 

Affiliated Tribes, the Fort Berthold Indian Reservation, to hold a 

hearing with then Congressman Penny of Minnesota and the late 

Congressman from Texas Mickey Leland, and we held a hearing on 

the Indian Reservation at Fort Berthold on the subject of diabetes. 

We had many people attend the hearing, who had lost arms and 

legs, who were on dialysis, who had chronic health problems, and 

they described a rate of diabetes that was ten times the national 

average. Not double, triple, quadruple, five times, but ten times the 

2 

national average. They said that adult Indians on that reservation 

over the age of 40, 50 percent of them had diabetes. 

Ultimately, I was able to help create and get funding for a diabetes treatment center and now they have a dialysis unit there. But 

it was the first time that I had had my eyes opened about this unbelievable scourge called diabetes, particularly as it affects American Indians. 

Diabetes is a disease that is on the rise all across our Country 

and it is a very serious issue. But a lot of people do not understand 

that it is a much more chronically prevalent issue on Indian reservations. 

I want to have a chart put up that shows that over 24 million 

people in this Country now have diabetes, 6 million undiagnosed 

and close to 50 million who are borderline diabetic. 

The CHAIRMAN. As you can see on this chart, the prevalence of 

diabetes in this Country has increased more than fourfold over 30 

years. The burden of this disease is even much more substantial, 

if we can show the second chart, on Indian reservations, among 

Native Americans. 

[The information referred to follows:] 


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The CHAIRMAN. Native Americans suffer the highest prevalence 

for diabetes of any population in our Country. As the second chart 

shows, more than 16 percent of American Indians suffer from diabetes. That is an average of all Native Americans. In fact, in some 

tribal communities, such as one in Arizona, more than 70 percent 

of the population has been diagnosed with diabetes. 

The outdated and the under-funded healthcare system on Indian 

lands also, I think, hinders the ability of Native Americans with diabetes from getting the kind of necessary treatment that is required. For the most part, this can be a treatable disease. But the 

lack of adequate treatment can lead to kidney failure, blindness, 

heart failure, stroke, amputation and more. 

A prime example is kidney failure. Native Americans are more 

than three times as likely as the general population to suffer from 

kidney failure as a result of diabetes. Kidney failure almost always 

requires dialysis. But until the passage of the Indian Healthcare 

Improvement Act just several months ago, a piece of legislation 

that we wrote in this Committee, the Indian Health Service did not 

have the authority to provide dialysis services to Native Americans 

suffering kidney failure. We need to improve diabetes treatment in 

a very substantial way. 

The Special Diabetes Program, first authorized in 1997, is a 

proven effort in combating diseases and diabetes. This program has 

led to clinical advancements in delaying the onset of diabetes and 

reducing the risk of serious complications, providing key programs 

to Native Americans. 

The Special Diabetes Program funding is going to expire in 2011. 

I have introduced legislation to reauthorize the program and I am 

proud to say that that bill now has 60 U.S. Senators as co-sponVerDate Nov 24 2008 10:52 Dec 03, 2010 Jkt 062518 PO 00000 Frm 00007 Fmt 6633 Sfmt 6633 S:\DOCS\62518.TXT JACK PsN: JACKF

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sors. I am working hard for the passage of this bill so that program 

can continue. It is very important. 

As I close, I want to share a story with you that I think highlights how important it is that we work for a cure for diabetes. I 

have a photograph here that I show you with the permission of the 

relatives. This is Isabel ‘‘Izzy’’ Burger. She is 11 years old and a 

member of the Little River Band of Ottawa Indians. Diagnosed 

with diabetes in 2007. She is a normal kid that likes to fish, hike, 

spend time with friends, but diabetes is always on her mind, always on her mind day and night. 

Her parents are fortunate to have private insurance, but they 

still face thousands and thousands of dollars in medical bills each 

year so that she can get the care she needs. And perhaps even 

harder she, like other diabetics, has to monitor her blood sugar levels and stick herself multiple times a day for testing. And in order 

for her to play at a friend’s house, to run outside, or even eat lunch 

at school, she has to prick her finger and check her blood sugar. 

She once wrote a letter to the President of the United States to 

talk about the issues that impact the lives of diabetic kids every 

single day. I believe that Izzy is with us here today. Izzy are you 

here? Can you stand up? 

We thank you very much for being with us today. We thank you 

for witnessing the kind of circumstances and the kind of treatment 

that is needed for diabetics of all ages, but especially diabetics who 

are young people who live on Indian reservations. Izzy, thank you 

for being with us. That is a pretty good picture of you, by the way. 

[Laughter.] 

5 

The CHAIRMAN. Let me, before I call on the witnesses, call on my 

colleagues for any comments. Again, as I said, we have held a number of hearings on diabetes because, if you go onto a reservation, 

you are not there very long without understanding that diabetes is 

a very special scourge to Native Americans. And it is something 

that we just have to continue to try to put all the spotlights together to find ways to address this. 

The CHAIRMAN. Senator Johnson? 

STATEMENT OF HON. TIM JOHNSON, 

U.S. SENATOR FROM SOUTH DAKOTA 

Senator JOHNSON. Thank you, Mr. Chairman, for holding this 

critical, important hearing. Too many of our Native people are affected by or susceptible to this devastating disease. The rates 

throughout Indian Country only continue to grow. I am looking forward to this testimony this morning as we seek solutions to reverse 

this trend. 

Thank you. 

The CHAIRMAN. Senator Tester? 

STATEMENT OF HON. JON TESTER, 

U.S. SENATOR FROM MONTANA 

Senator TESTER. Yes, thank you, Mr. Chairman. And, as always, 

I appreciate you bringing forth an issue that is critically important 

to Indian Country, critically important to the Country as a whole. 


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As I go around the State of Montana and visit with my friends in 

Indian Country, almost without exception healthcare is the number 

one issue and diabetes is the number one issue when we talk about 

healthcare in Indian Country. 

And we have got to have healthy adults to have good parents. 

And we have got to have healthy kids to be good students. And we 

need healthy elders for good roll models. 

The statistics are plain, they are clear. We have got an incredible 

problem that we need to do our level best to address, 2.6 times 

more likely to be diagnosed with diabetes if you are Native American. The death rate is 3 times higher from diabetes than the rest 

of society. 

There are opportunities out there. Education, of course, is one of 

the keys. Education on the traditional skills, fitness and recreation, 

foods and recipes, expertise consulting service and provisions of instructional material, all those things are critically important to utilize through travel colleges and high schools and elementary 

schools as we go forth. 

There is one other thing that I think we should be doing. We 

should really be focusing on technology and stem cell research and 

those kinds of things to really get to the root of it with Indian 

Country a part of those research projects. 

It is, we have had, or I have been a part of at least, several hearings on diabetes, both in this Committee and other Committees. It 

is, from my perspective, and I am not a diabetic, but I have got a 

close, close personal friend who is, it is a terrible disease to have 

to live with because, as Senator Dorgan pointed out as the picture 

of Izzy was up on the board, it is something that I think diabetics 

think about every day when they wake up and every night when 

they go to bed and the time that is in between. It has incredible 

challenges associated with it. 

So, hopefully this hearing will step us on a path to really come 

forth with some solutions and ideas to address this problem in Indian Country and, quite honestly, throughout the Country. I think 

it behooves us all to address it here because it is such an epidemic, 

but also throughout the whole Country. So, hopefully in Indian 

Country we can lead the way on this. 

Thank you, Mr. Chairman. I appreciate the opportunity. 

The CHAIRMAN. Senator Tester, thank you very much. Senator 

Tester and I held a hearing on the Crow Nation Indian Reservation 

in Montana a while ago, and the discussion included the issue of 

diabetes. This is true of almost any hearing on any reservation. 

I want to introduce all of the witnesses and then I will call on 

Dr. Judith Fradkin first. 

Dr. Fradkin is a medical doctor with the National Institutes of 

Health conducting research on diabetes and she is going to tell us 

about diabetes and the progress made in that field in recent years. 

Dr. Fradkin, thank you very much for being with us. 

Mr. Wes Studi is an actor and a Native American health advocate in Santa Fe, New Mexico. I know Mr. Studi, not personally, 

but I know him from the Last of the Mohicans and from Dances 

with Wolves, two movies that I enjoyed very much and enjoyed especially your performance, Mr. Studi. 

7 

He is an actor and Native American health advocate living in 

Santa Fe, New Mexico and he will highlight the prevalence of diabetes in the United States, including in tribal communities, and 

talk about what is being done to address the rate of diabetes and 

what more can and must be done to combat the disease. 

Mr. Gary Hall is an Olympian swimmer and, like most swimmers, is a tall guy. I met him this morning. I had not met Mr. Hall 

before, but all very fast swimmers seem to me to be fairly tall. He 

is a three-time Olympian and a ten-time Olympic medalist in 

swimming. He will talk about his own experience living as a competitive athlete with Type I Diabetes. 

He will also testify about recent advances in diabetes management and progress and trying to find a cure. He has his own foundation dedicated to raising awareness and funding diabetes research. 

Dr. Melvina McCabe is a physician, the President of the Association of American Indian Physicians in Albuquerque, New Mexico. 

She will describe recent research conducted on the prevalence of diabetes among Native Americans including prevention, education 

and treatment. Also, her experience, she will discuss, as a physician working with tribal communities in trying to prevent treating 

diabetes. 

And finally, Caitlin Baker is a 16-year-old Muscogee Creek Indian from Oklahoma, a Native American youth and competitive 

swimmer. She works with Native youth, educating them on the importance of a healthy lifestyle including the importance of diabetes 

prevention. She will discuss these efforts and her organization. Her 

organization is CAITLINB, which stands for Competitive American 

Indians Turning Lifestyles Into New Beginnings, a clever use of 

your name, I might say. 

[Laughter.] 

The CHAIRMAN. Let us begin with Dr. Fradkin. Thank you very 

much for being with us, and thanks for your work at the National 

Institutes of Health. You may proceed. 

And I would say to all of the witnesses that your entire statement will be made a part of the permanent record of this Committee, so you are free to summarize. 

STATEMENT OF JUDITH E. FRADKIN, M.D., DIRECTOR, 

DIVISION OF DIABETES, ENDOCRINOLOGY AND 

METABOLIC DISEASES, NATIONAL INSTITUTE OF DIABETES 

AND DIGESTIVE AND KIDNEY DISEASES, NATIONAL 

INSTITUTES OF HEALTH, U.S. DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Dr. FRADKIN. Mr. Chairman and Members of the Committee, as 

Director of the Division of Diabetes, Endocrinology and Metabolic 

Diseases at the National Institute of Diabetes and Digestive and 

Kidney Diseases, thank you for the invitation to participate and 

testify at this hearing on diabetes. 

On behalf of the NIDDK and the National Institutes of Health, 

I am pleased to report that we are vigorously pursing research on 

diabetes and its complications. A high priority of NIH-supported research is to understand and to eliminate the disproportionate burden that diabetes places on minority groups including American InVerDate Nov 24 2008 10:52 Dec 03, 2010 Jkt 062518 PO 00000 Frm 00011 Fmt 6633 Sfmt 6633 S:\DOCS\62518.TXT JACK PsN: JACKF
8 

dians, the population, as you just noted, that has the highest rate 

of diabetes in the United States. 

Today I would like to tell you about NIH-supported diabetes research, including research supported by the Special Statutory 

Funding Program for Type I Diabetes Research, which the NIDDK 

administers. 

This program was established by Congress for research on the 

prevention and cure of Type I Diabetes and has resulted in many 

scientific advances that are improving the health and quality of life 

of people with diabetes. 

A parallel funding stream, the Special Diabetes Program for Indians, is administered by the Indian Health Service and has led to 

substantial improvements in diabetes care in the American Indian 

population. 

Mr. Chairman, the need to pursue research on the prevention, 

treatment and cure of diabetes is greater than ever because the 

rates of several types of diabetes are rising. The good news is that 

we have made tremendous progress in recent years which has led 

to improvements in survival and quality of life for people with diabetes. 

Now, thanks to continuous glucose monitoring technology, some 

parents of young children with Type I Diabetes can sleep through 

the night without having to arise repeatedly to check the child’s 

blood glucose levels. This device measures blood glucose levels 

every few minutes and sounds an alarm if levels are above or below 

target, a technological peace of mind allowing parents to sleep 

more soundly. The development of this technology was supported, 

in part, by the NIH’s Special Diabetes Program. 

Because genetic and antibody tests can now predict with great 

accuracy which children will develop Type I Diabetes, we can now 

test prevention strategies. To find new approaches to prevention, 

we launched the TEDDY study, which is supported by the Special 

Diabetes Program. 

TEDDY researchers have screened over 400,000 newborns to determine if they have genes that put them at increased risk for Type 

I Diabetes. Over 8,000 of these newborns are enrolled in the study 

and are being followed until age 15, with a goal of identifying environmental triggers of Type I Diabetes. 

To date, the number of children who have developed 

autoimmunity and Type I Diabetes is exactly as predicted, showcasing the tremendous power of these predictive tests. 

The Special Diabetes Program’s SEARCH for Diabetes in Youth 

study is, for the first time, telling us how many children in the U.S. 

have diabetes, and we will be able to see how these rates change 

over time. 

We can prevent or delay the development of Type II Diabetes in 

people at high risk for this disease as demonstrated by the NIDDKled Diabetes Prevention Program clinical trial. A modest amount of 

weight loss through diet changes and moderate exercise substantially reduced the occurrence of Type II Diabetes at 3, and now at 

10 years, after enrollment in the trial. 

This intervention worked in all ethnic and racial groups studied, 

including American Indian populations. The IHS has utilized fundVerDate Nov 24 2008 10:52 Dec 03, 2010 Jkt 062518 PO 00000 Frm 00012 Fmt 6633 Sfmt 6633 S:\DOCS\62518.TXT JACK PsN: JACKF
9 

ing from the Special Diabetes Program for Indians to launch prevention efforts based on these findings. 

For people who already have diabetes, IHS efforts supported by 

the Special Diabetes Program for Indians have improved blood glucose control among American Indian populations as measured by 

the A1c test. This is important because NIH-sponsored trials found 

that good A1c control reduced rates of diabetes complications. 

The Type I Diabetes Special Program has supported successful 

efforts to standardize A1c measurements in clinical laboratories 

across the Country so physicians can reliably monitor glucose control. This standardization has made possible improvements in A1c 

levels nationwide, including in vulnerable populations such as 

American Indians and Alaskan Natives. 

Diabetes during pregnancy brings risk to mother and child. Because of the NIH-supported Hyperglycemia and Adverse Pregnancy 

Outcome Study, we now have precise information on what blood 

glucose levels should be during pregnancy to avoid complications 

near birth. 

These are just a few examples of how far we have come in recent 

years through vigorous support of research toward increasing 

knowledge of diabetes and improving the health of people with the 

disease. However, much work needs to be done to curb the diabetes 

epidemic. 

For example, it is critical to move beyond continuous glucose 

monitoring technology and link glucose monitoring to insulin delivery to create a so-called artificial pancreas. This technology could 

help patients achieve good blood glucose control that has been 

shown to reduce complications and alleviate the burden of self-care 

that you just spoke about so eloquently. 

Now that we have thousands of samples collected through the 

TEDDY Study, it is vital to use new and emerging technologies to 

analyze those samples and identify environmental triggers of Type 

I Diabetes. 

Building on the success of many new available medicines for 

Type II Diabetes, comparative effectiveness research can help inform doctors’ decisions about what medications to prescribe for 

their patients and when. 

Perhaps most important to combating the diabetes epidemic is 

reversing the trend of both Type I and Type II Diabetes occurring 

at younger ages because earlier onset of disease means earlier development of complications and premature mortality. 

For women, earlier development of diabetes also endangers her 

offspring. The inter intrauterine environment plays an important 

role, not only in problems at the time of birth, but also in the future development of diabetes and obesity, a finding observed among 

the Pima Indians in Arizona. Thus, it is critical to pursue research 

to break the vicious cycle of ever-growing rates of diabetes by preventing or mitigating the effects of diabetes and obesity during 

childbearing years and pregnancy. 

By building on recent advances in diabetes research, we are 

poised to realize even greater improvements in the health and 

quality of life of people with diabetes. We have come far, but we 

must come further. 

10 

Thank you, Mr. Chairman, for your leadership in calling this 

hearing to continue focusing attention on the importance of diabetes research and for your continued support of NIH research. 

[The prepared statement of Dr. Fradkin follows:] 

PREPARED STATEMENT OF JUDITH E. FRADKIN, M.D., DIRECTOR, DIVISION OF

DIABETES, ENDOCRINOLOGY AND METABOLIC DISEASES, NATIONAL INSTITUTE OF

DIABETES AND DIGESTIVE AND KIDNEY DISEASES, NATIONAL INSTITUTES OF

HEALTH, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES


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The CHAIRMAN. Dr. Fradkin, thank you very much for your testimony. There is some hopeful testimony in that statement. I appreciate that a lot. 

Mr. Studi, I did not mention, I see from the biography that you 

also were involved in the film Avatar but, since I am one of the 

few Americans, based on gross receipts from the box office, that did 

not see Avatar, I forgot to mention—— 

Mr. STUDI. That is three people that I know now. 

[Laughter.] 

The CHAIRMAN. Yes, well, Senator Tester and I are two of the 

three. 


630b14.eps
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[Laughter.] 

Mr. STUDI. You were supposed to keep that to yourself. 

[Laughter.] 

Mr. STUDI. There is a rumor it may be re-released, this summer. 

[Laughter.] 

The CHAIRMAN. Thank you for being here, and why don’t you proceed. 

STATEMENT OF WES STUDI, PROFESSIONAL ACTOR; MEMBER, 

CHEROKEE NATION 

Mr. STUDI. Chairman Dorgan and other members of the Committee, I am honored to be here this morning. And thank you for 

the opportunity to participate in today’s Oversight Hearing entitled 

A Way Out of the Diabetes Crisis in Indian Country. 

My name is Wes Studi and I am a member of the Cherokee Nation of Oklahoma. And while I currently reside in Santa Fe, New 

Mexico, I was born in a place in called Nofire Hollow between Tahlequah and Stillwell in Northeastern Oklahoma. 

Now, as a son of a ranch worker, I attended a number of elementary schools throughout Northeastern Oklahoma and finally wound 

up at a Chilocco Indian agricultural school in Northern Oklahoma 

as a high schooler. 

My first language is Cherokee and I strongly believe in the importance of handing down our language, customs and rich traditions from one generation to the next. I have written two children’s 

books in Cherokee and English both for the Cherokee Bilingual 

Education Cross Cultural Center in Tahlequah, Oklahoma and I 

am proud also to have served our nation in combat during the Vietnam War. 

And I am very fortunate to have a very, well, I say very, successful film career. I played roles in several, or many motion pictures 

actually, including Dances with Wolves, the Last of the Mohicans, 

Geronimo and, yes, as you mentioned, the recent Avatar. 

Now, in my film career, I have often portrayed fearless leaders 

who have battled and fought against formidable challenges. I am 

also very proud to be here today to honor, actually more proud to 

be here to honor the leaders in American Indian and Alaska Native 

communities who have committed themselves to the fight against 

diabetes. 

Now, I am not a scientist or a doctor. I am simply a tribal member who fully understands the toll diabetes has taken, and it 

reaches far beyond the tribal communities. And clearly, the United 

States has a diabetes epidemic on its hands. 

While we are now beginning to see the costly and damaging effects of this disease in the rest of the nation, it is a problem that 

is all too familiar for those of us in the Indian Country. For years, 

Type II Diabetes has ravaged tribal communities and has had a 

devastating physical, emotional and spiritual impact on our people. 

I have family members and friends living with diabetes and I 

know people in our community who have endured amputations and 

other devastating complications of diabetes as a result of not having access to quality diabetes care. 

Our American Indian and Alaska Native communities have the 

highest rate of diabetes, as you mentioned, more than double the 

25 

prevalence of the general population. In some of our communities, 

more than half of all adults have been diagnosed with diabetes and 

diabetes in our youth is on the rise. 

We suffer the highest rates of complications and mortality from 

diabetes, more than three times the national average. We are getting diabetes at earlier ages and are dying in greater numbers from 

the disease when compared with the rest of the Nation. 

However, our story is not just one of suffering, misery and despair. It is also a story of great perseverance, determination and 

hope for the future. Tribal communities have come together to fight 

back against diabetes and the destruction it has wrought. Across 

Indian Country, there are inspiring stories of elders, community 

leaders, women, men and children who have been empowered with 

the knowledge, and tools, to effectively combat this disease. 

This great work and progress is not accomplished by tribal communities alone. It takes a partnership with and resources from the 

Federal Government to support the continued research, education, 

outreach and range of services that have gone into this momentous 

effort. The success of the Special Diabetes Program, SDP, in particular demonstrates what can be accomplished when we work together. 

Established more than a decade ago, the Special Diabetes Program, made up of the Special Diabetes Program for Indians and 

the Special Diabetes Program for Type I Diabetes, has made significant strides against this disease and has dramatically improved 

the lives of those with, and risk for, diabetes. 

The SDPI now has a presence in 35 States and supports over 450 

Indian Health Service tribal and urban Indian health programs. It 

has allowed tribal communities to implement a wide range of strategies to address the burden of diabetes in a manner that is most 

effective and culturally appropriate for our diverse and unique communities. 

These efforts have shown great success in managing the disease 

by delaying or eliminating the development of complications and, 

in some people, preventing the onset of diabetes altogether. 

The American Diabetes Association, the National Indian Health 

Board and the Juvenile Diabetes Research Foundation recently 

joined together to collect stories from many people whose lives have 

benefitted from the Special Diabetes Program. The strength, courage and resolve of these citizens rival any of the characters I have 

ever played on the big screen. I would like to highlight the story 

of one woman from North Carolina who has taken control of her 

diabetes and her life. 

Ulela Harris of the Eastern Band of Cherokee Indians was diagnosed with diabetes in 1993. Now, although she had eight brothers 

and sisters with diabetes and lost both her father and sister to 

complications from the disease, she still did not understand what 

diabetes was and lacked the knowledge to manage it effectively. At 

the time of her diagnosis, there was limited clinical support for diabetes management and she was seen by a nutritionist and sent 

home with medications. 

After many years of insulin injections and oral medications, her 

blood sugar levels were still dangerously high and, in 2007, Ulela 

joined the Cherokee Diabetes Prevention Program, which provided 

26 

her access to the critical case management and diabetes education 

she needed to manage her diabetes. 

One year later, she was able to bring her diabetes under control 

and no longer required insulin or oral diabetes medication. 

Through this program, she also lost 35 pounds and has been motivated to take on new challenges such as the First Annual Cherokee 

Ironman-Ironwoman Triathlon. 

It is through the power of story that our American Indian and 

Alaska Native culture and traditions are passed on from one generation to the next. And Ulela’s story is one of the many being told 

throughout our communities that are gradually replacing stories of 

the fear and pain of diabetes with new stories of inspiration and 

hope for our future generations. 

Native people have made significant contributions to the current 

understanding of effective diabetes treatment and prevention. The 

research conducted among the Pima Indians in the early 1960s 

alerted this nation to the epidemic of diabetes today. 

Today, we are proving that given the appropriate resources and 

tools to address diabetes, we can make great progress in conquering the challenges of diabetes and saving lives. 

While we have hope for the future, the journey is far from over. 

To continue on this path of hope and progress, we need more resources to conduct research, provide assistance, and purchase the 

medications necessary, the medications necessary to sustain and 

expand our SDPI diabetes treatment and prevention programs. 

I would like to personally thank you, Chairman Dorgan, for your 

commitment to the health and well-being of Native people, especially for your leadership to reauthorize the Special Diabetes Program. With ongoing support from members of this Committee, the 

Congress, tribal communities and the Indian Health System, we 

can continue to work in partnership to change the landscape of diabetes and transform the overall health and wellness of American 

Indian and Alaska Native people. 

Together, we can continue to fight diabetes, for our ancestors, 

our tribal communities and our future generations. 

Thank you so much for the opportunity to be here today. Thank 

you so much. 

[The prepared statement of Mr. Studi follows:] 

PREPARED STATEMENT OF WES STUDI, PROFESSIONAL ACTOR; MEMBER, CHEROKEE

NATION

Chairman Dorgan, Vice Chairman Barrasso, other members of the Committee, I 

am honored to be here this morning. Thank you for the opportunity to participate 

in today’s oversight hearing entitled ‘‘A Way Out of the Diabetes Crisis in Indian 

Country and Beyond.’’ 

My name is Wes Studi and I am an enrolled member of the Cherokee Nation. 

While I currently reside in New Mexico, I was born in Nofire Hollow, Oklahoma (between Stillwell and Tahlequah). As the son of a ranch worker, I attended a number 

of elementary schools growing up but settled on the Chilocco Indian Boarding School 

in Northern Oklahoma as a teenager. My first language is Cherokee and I strongly 

believe in the importance of handing down our language, customs, and rich traditions from one generation to the next. I have written two children’s books in Cherokee for the Cherokee Bilingual/Cross Cultural Education Center. 

I am proud to have served our nation in combat during the Vietnam War, and 

I am very fortunate to have a successful film career. I have played roles in several 

major motion pictures including, ‘‘Dances with Wolves,’’ ‘‘Last of the Mohicans,’’ ‘‘Geronimo: An American Legend,’’ and most recently ‘‘Avatar.’’ In my film career I have 

27 

often portrayed fearless leaders who have battled and fought against formidable 

challenges. 

I am also very proud to be here today to honor the leaders in American Indian 

and Alaska Native communities who have committed themselves to the fight against 

diabetes. 

The Burden of Diabetes in American Indian/Alaska Native Populations 

I’m not a scientist or a doctor; I am a tribal community member, who fully understands the toll diabetes has taken, reaching far beyond our tribal communities. 

Clearly, the United States has a diabetes epidemic on its hands. While we are now 

beginning to see the costly and damaging effects of this disease in rest of the nation, 

it is a problem that is all too familiar for those of us in Indian Country. For years, 

type 2 diabetes has ravaged tribal communities and has had a devastating physical, 

emotional, and spiritual impact on our people. I have family and friends living with 

diabetes and I know people in our community who have endured amputations and 

other devastating complications of diabetes as a result of not having access to quality diabetes care. 

Our American Indian and Alaska Native communities have the highest rates of 

diabetes—more than double the prevalence of the general population. In some of our 

communities, more than half of all adults have been diagnosed with diabetes and 

diabetes in our youth is on the rise. We suffer the highest rates of complications 

and mortality from diabetes, more than three times the national average. We are 

getting diabetes are earlier ages and are dying in greater numbers from the disease 

when compared with the rest of the nation. 

The Battle Against Diabetes 

However, our story is not just one of suffering, misery and despair—it is also a 

story of great perseverance, determination and hope for the future. Tribal communities have come together to fight back against diabetes and the destruction it has 

wrought. Across Indian Country, there are inspiring stories of elders, community 

leaders, women, men, and even children, who have been empowered with the knowledge and tools to effectively combat this disease. 

This great work and progress is not accomplished by tribal communities alone. It 

takes a partnership with, and resources from, the federal government to support the 

continued research, education, outreach, and range of services that have gone into 

this momentous effort. The successes of the Special Diabetes Program (SDP) in particular demonstrate what can be accomplished when we work together. 

Established more than a decade ago, the Special Diabetes Program, made up of 

the Special Diabetes Program for Indians (SDPI) and the Special Diabetes Program 

for Type 1 Diabetes, has made significant strides against this disease and have dramatically improved the lives of those with, and at risk for, diabetes. The SDPI now 

has a presence in 35 states and supports over 450 Indian Health Service, Tribal and 

Urban Indian health programs. It has allowed tribal communities to implement a 

wide range of strategies to address the burden of diabetes in a manner that is most 

effective and culturally appropriate for our diverse and unique communities. These 

efforts have shown great success in managing the disease by delaying or eliminating 

the development of complications, and in some people, preventing the onset of diabetes all together. 

Taking Control 

The American Diabetes Association, the National Indian Health Board, and the 

Juvenile Diabetes Research Foundation recently joined together to collect stories 

from the many people whose lives have benefitted from the Special Diabetes Program. The strength, courage and resolve of these citizens rival any of the characters 

I have portrayed on the big screen. I would like to highlight the story of one woman 

from North Carolina who has taken control of her diabetes and her life. Ulela Harris of the Eastern Band of Cherokee Indians was diagnosed with diabetes in 1993. 

Although she had eight brothers and sisters with diabetes and lost both her father 

and sister to complications from the disease, she still didn’t understand what diabetes was and lacked the knowledge to manage it effectively. At the time of her diagnosis, there was limited clinical support for diabetes management and she was seen 

by a nutritionist and sent home with medications. After many years of insulin injections and oral medications, her blood sugar levels were still dangerously high. In 

2007, Ulela joined the Cherokee Diabetes Prevention Program, which provided her 

access to the critical case management and diabetes education she needed to self 

manage her diabetes. One year later, she was able to bring her diabetes under control and no longer required insulin or oral diabetes medications. Through this program, she lost 35 pounds and has been motivated to take on new challenges, such 

as the first annual Cherokee Ironman-Ironwoman Triathlon. 

28 

It is through the power of story that our American Indian and Alaska Native culture and traditions are passed on from one generation to the next. Ulela’s story is 

one of the many being told throughout our communities that are gradually replacing 

stories of the fear and pain of diabetes with new stories of inspiration and hope for 

our future generations. 

Hope for the Future 

Native people have made significant contributions to the current understanding 

of effective diabetes treatment and prevention. The research conducted among the 

Pima Indians in the early 1960’s alerted this nation to the epidemic of diabetes. 

Today, we are proving that, given the appropriate resources and tools to address diabetes, we can make great progress in conquering the challenges of diabetes and 

saving lives. 

While we have hope for the future, the journey is far from over. To continue on 

this path of hope and progress, we need more resources to conduct research, provide 

assistance, and purchase the medications necessary to sustain and expand our SDPI 

diabetes treatment and prevention programs. 

I would like to personally thank you Chairman Dorgan for your commitment to 

the health and well being of our Native people, especially for your leadership to reauthorize the Special Diabetes Program. With ongoing support from members of this 

committee, the Congress, tribal communities, and the Indian health system, we can 

continue to work in partnership to change the landscape of diabetes and transform 

the overall health and wellness of American Indian and Alaska Native people. Together, we can continue to fight diabetes, for our ancestors, our tribal communities 

and our future generations. 

Thank you for the opportunity to be here before you today. I would be happy to 

answer any questions you may have for me. 

The CHAIRMAN. Mr. Studi, thank you very much for your passion 

and your willingness to come to Washington, D.C. and provide that 

testimony. 

And Mr. Gary Hall. Mr. Hall, thank you for traveling here as 

well. I believe you told me you are from Seattle, so that is some 

long distance. We appreciate your work and your willingness to testify. You may proceed. 

STATEMENT OF GARY HALL, JR., THREE–TIME OLYMPIAN 

SWIMMER, TEN–TIME OLYMPIC MEDALIST 

Mr. HALL. Good morning. Thank you, Chairman Dorgan. And 

members of the Committee, thank you. 

My name is Gary Hall, Jr. It is my honor to appear before you 

today to speak about the influence of Type I Diabetes on my life 

and the impact of research in managing and preventing and curing 

diabetes. 

My family’s ties to swimming run deep and I have been drawn 

to the water my entire life. I won my first national title when I was 

18, and continued my success at the University of Texas, after 

which I won two gold and two silver medals at the 1996 Olympics. 

Things were going according to plan and I felt really good about my 

path in life. 

In 1999, my world changed. Having no previous exposure to diabetes, I was caught off guard when I started experiencing symptoms of the disease. I was extremely tired, constantly dehydrated, 

and had blurred vision. Finally, I collapsed. 

I was diagnosed with Type I Diabetes. My immune system was 

attacking the insulin-producing cells in my pancreas, and I would 

need to inject or pump insulin into my body several times a day, 

every day, for the rest of my life. My entire life had changed forever. 

29 

My previous focus on training shifted to learning of insulin shots, 

glucose tests and carbohydrate ratios. I took time off from swimming and, with the help of the Juvenile Diabetes Research Foundation, devoted myself to researching this disease. 

It shocked me to learn about the complications associated with 

both Type I and Type II Diabetes. Blindness, amputations, kidney 

failure and stroke were now closer to becoming a reality for me 

than I ever thought. 

Diabetes is a terrifying disease. But I resolved not to let it stop 

me or the pursuit of my dreams. I soon returned to swimming determined not only to win at the sport, but also to show the world 

I could do it with diabetes. And as I sit before you today, I am 

proud to say I accomplished just that. Since being diagnosed with 

Type I Diabetes, I won six medals at the 2000 and 2004 Olympic 

Games for the United States. 

All of my accomplishments cannot change the severity of this disease and the heavy toll it is taking on my body. While I hope that 

my story is an inspiration for those living with diabetes, I must say 

that all of the children, adults and families impacted by this disease are truly the greatest inspiration to me. Knowing the reality 

of life with diabetes, I am constantly amazed at the stories of families and individuals who give back while persevering through this 

disease. 

Take Anela from Hawaii, who was diagnosed with Type I Diabetes when she was 9 years old. She is so determined to be part of 

the cure that she enrolled in a research trial studying the environmental factors that may contribute to diabetes. Anela is actively 

helping researchers determine the cause of diabetes so they can 

find a cure for it. 

Another example is Scott from Nevada, whose son was diagnosed 

with Type I Diabetes when he was 8 years old. With no family history of diabetes, Scott enrolled in a clinical research study that 

showed he was at high risk for developing diabetes. 

Five years later, when he was eventually diagnosed, he immediately enrolled in another study to test a drug designed to halt the 

autoimmune attack involved in Type I Diabetes. Years later, Scott 

still produces some of his own insulin, and the drug appears to be 

slowing the progression of the disease and the development of complications. 

By participating in research, Anela and Scott have contributed to 

the tremendous advancement in diabetes treatments and technologies that are improving the lives of people living with diabetes. 

These advancements would not be possible without the Special 

Diabetes Program, which funds 35 percent of all diabetes research 

at the National Institutes of Health. This program supports the 

large-scale, multi-center research trials like the ones Anela and 

Scott participated in, and also funds critical diabetes education, 

treatment and prevention programs for Native Americans. 

Thanks to the Special Diabetes Program, research has moved 

from the lab to human clinical trials that are identifying those at 

high risk for Type I Diabetes and testing therapies to prevent the 

onset of the disease and slow its progression. This program is funding groundbreaking research to help advance an artificial pancreas 

30 

that would help patients achieve better glucose control, reducing 

the risk of diabetes complications. 

And on the complications front, a clinical trial funded by the Special Diabetes Program recently confirmed the ability to halt, and 

even reverse, diabetic eye disease, or retinopathy, which is the 

leading cause of adult onset blindness. 

I would like to offer a special thanks to Chairman Dorgan for 

sponsoring legislation, along with Senator Susan Collins, to renew 

the Special Diabetes Program this year. Mr. Chairman, your extraordinary leadership and commitment to renew this program is 

deeply appreciated by me and all people living with diabetes. 

I would also like to thank Vice Chairman Barrasso and the members of this Committee, a majority of which are co-sponsors of Senator Dorgan’s legislation, S. 3058. This program is drastically 

changing, if not saving, the lives of countless Americans living with 

diabetes. Its renewal will bring us one step further along on our 

path to a cure for this devastating disease, and provides hope. 

Thank you again for having me here today and for your commitment to diabetes research and the individuals across this Country 

living with diabetes. 

Thank you. 

[The prepared statement of Mr. Hall follows:] 

PREPARED STATEMENT OF GARY HALL, JR., THREE-TIME OLYMPIAN SWIMMER, 

TEN-TIME OLYMPIC MEDALIST

Good morning. Thank you Chairman Dorgan, Vice Chairman Barrasso, and members of the Committee. My name is Gary Hall, Jr., and it is my honor to appear 

before you today to speak about the influence of type 1 diabetes on my life and the 

impact of research in managing, preventing and curing diabetes. 

My family’s ties to swimming run deep, and I’ve been drawn to the water my entire life. I won my first national title when I was 18 and continued my success at 

the University of Texas, after which I won 2 gold and 2 silver medals in the 1996 

Olympics. Things were going according to plan, and I was feeling really good about 

my path in life. 

In 1999, my world changed. Having no previous exposure to diabetes, I was 

caught off guard when I started experiencing symptoms of the disease. I was extremely tired, constantly dehydrated, and had blurred vision. Finally, I collapsed. 

Later in the hospital, I was diagnosed with type 1 diabetes. My immune system 

was attacking the insulin-producing cells in my pancreas, and I would need to inject 

or pump insulin into my body several times a day, every day, for the rest of my 

life. Within hours, my entire life had changed forever. My previous focus on training 

shifted to learning of insulin shots, glucose tests and carbohydrate ratios. 

I took time off from swimming and, with the help of the Juvenile Diabetes Research Foundation, devoted myself to researching this disease. It shocked me to 

learn about the complications associated with both type 1 and type 2 diabetes. 

Blindness, amputations, kidney failure and stroke were now closer to becoming a 

reality for me than I had ever imagined. Diabetes is a terrifying disease, but at that 

moment, I resolved not to let it stop me or the pursuit of my dreams. 

I soon returned to swimming, determined not only to win at the sport, but also 

to show the world I could do it with diabetes. And as I sit before you today, I am 

proud to say I accomplished just that. Since being diagnosed with type 1 diabetes, 

I have won 6 medals in the 2000 and 2004 Olympic games. 

All of my accomplishments can’t change the severity of this disease and the heavy 

toll it is taking on my body. While I hope that my story is an inspiration for those 

living with diabetes, I must say that all of the children, adults, and families impacted by this disease are truly the greatest inspiration to me. Knowing the reality 

of life with diabetes, I am continually amazed at the stories of families and individuals who give back while persevering through this disease. 

Take Anela from Hawaii, who was diagnosed with type 1 when she 9 years old. 

She is so determined to be a part of the cure that she enrolled in a research trial 

studying the environmental factors that may contribute to diabetes. Anela is acVerDate Nov 24 2008 10:52 Dec 03, 2010 Jkt 062518 PO 00000 Frm 00034 Fmt 6633 Sfmt 6621 S:\DOCS\62518.TXT JACK PsN: JACKF
31 

tively helping researchers determine the cause of diabetes so they can find a cure 

for it. 

Another example is Scott from Nevada, whose son was diagnosed with type 1 diabetes when he was eight years old. With no family history of diabetes, Scott enrolled 

in a clinical research study that showed he was at high risk of developing diabetes. 

Five years later, when he was eventually diagnosed, he immediately enrolled in another study to test a drug designed to halt the autoimmune attack involved in type 

1 diabetes. Years later, Scott still produces some of his own insulin, and the drug 

appears to be slowing the progression of the disease and the development of complications. 

By participating in research, Anela and Scott have contributed to the tremendous 

advancements in diabetes treatments and technologies that are improving the lives 

of people living with diabetes. These advancements would not be possible without 

the Special Diabetes Program, which funds 35% of all diabetes research at the National Institutes of Health. This program supports the large scale, multi-center research trials like the ones Anela and Scott participated in and also funds critical 

diabetes education, treatment and prevention programs for Native Americans. 

Thanks to the Special Diabetes Program, research has moved from the lab to 

human clinical trials that are identifying those at high risk for type 1 diabetes and 

testing therapies to prevent the onset of the disease and slow its progression. This 

program is funding groundbreaking research to help advance an artificial pancreas 

that would help patients achieve better glucose control, reducing the risk of diabetes 

complications. And on the complications front, a clinical trial funded by the Special 

Diabetes Program recently confirmed the ability to halt and reverse diabetic eye disease, which is the leading cause of adult onset blindness. 

I would like to offer a special thanks to Chairman Dorgan for sponsoring legislation along with Sen. Susan Collins to renew the Special Diabetes Program this year. 

Mr. Chairman, your extraordinary leadership and commitment to renew this program this year is deeply appreciated. I would also like to thank Vice Chairman Barrasso and the members of this committee, a majority of which are co-sponsors of 

Sen. Dorgan’s legislation, S. 3058. This program is drastically changing—if not saving—the lives of countless people with diabetes. Its renewal will bring us one step 

farther along on our path to a cure for this devastating disease. 

Thank you again for having me here today and for your commitment to diabetes 

research and individuals across this country living with diabetes. 

Thank you again for having me here today. 

The CHAIRMAN. Mr. Hall, thank you very much. Your story is a 

very inspiring one to all of us, and we appreciate you being here. 

Dr. Melvina McCabe, thank you for being here. President of the 

Association of American Indian Physicians in Albuquerque. You 

may proceed. 

STATEMENT OF MELVINA MCCABE, M.D., PRESIDENT, 

ASSOCIATION OF AMERICAN INDIAN PHYSICIANS 

Dr. MCCABE. Chairman Dorgan, thank you very much. Other 

Committee members, I thank you very much for inviting me to testify. And it is an honor for me to testify on behalf of my people. 

Diabetes is truly a crisis in Indian Country. The crisis is all-encompassing, affecting not only the physical health of our Indian 

Nations, but also affecting the mind and the spirit. As one of our 

own stated, when the spirit is in pain, what does it matter if you 

take your medication or take a walk? 

I will present the data, some of the data, in Indian Country and 

some of the findings to date on activities that have been implemented in Indian Country. 

Senator Dorgan, you presented many of the statistics already. 

The one thing I would like to add is that the Indian Health Service 

data on American Indians and Alaska Native children and young 

people, between 1990 and 2009, reveals a 161 percent increase in 

Type II Diabetes in those aged less than 15 years. Diabetes and the 

32 

co-existing morbidities continue to plague our Native peoples and, 

in particular, diabetes is now affecting those very dear to us, our 

children and our young people. 

The lifestyle interventions of weight loss and exercise remain the 

mainstay in diabetes prevention and cardiovascular risk reduction. 

For every kilogram of weight loss, there is a 16 percent decrease 

in diabetes risk. The development of new diabetes medications is 

not to be minimized, but lifestyle interventions are key. 

Other panel members have referenced the Diabetes Prevention 

Program. Some of the statistics that came out of that program are 

a 58 percent reduction in diabetes incidents with the intensive lifestyle intervention group, and a 31 percent reduction in the 

Metformin compared to placebo. 

A promising trend in diabetes outcomes is noted with the implementation of the Indian Health Services Special Diabetes Programs 

for Indians. After 1998, community walking and running programs 

increased from 20 to 92 percent. Community exercise programs increased from 16 to 69 percent. School age physical activity programs increased from 9 to 69 percent. Tribally-defined interventions in reduction in TV watching increased from 25 to 35 percent. 

And weight management programs for children increased from 8 to 

72 percent. 

The improvement in clinical interventions was a reduction of the 

A1c from 11 to 7.9 percent, a reduction in the cholesterol levels by 

20 percent, and a reduction in proteinuria by 32 percent. 

The Journey to Native Youth Health Project is a collaborative, 

community-based participatory approach partnership between the 

Montana Rocky Boy and Crow Indian reservations and the University of Montana for preventing risk factors associated with diabetes 

in Native youth aged 10 to 14. The early findings from this study 

strongly suggests this intervention favorably impacts diabetes risk 

factors in Native youth by increasing moderate to vigorous activity 

and increasing caloric output. 

They have submitted a full-scale trial for funding. They have not 

heard back yet. Senator Tester, this would be exciting news for 

your State if this grant was funded. 

The Navajo Nation has adapted the Diabetes Prevention Program materials for youth and Navajo people in their efforts to reduce diabetes. In addition, they have chosen to share with anyone 

their materials and have conducted training around the U.S. to implement this effective intervention. Senator McCain, your State 

needs to be congratulated for producing leaders in diabetes reduction efforts and who are willing to share their experience. 

The Pima Indians, since 1990, have experienced a decline, albeit 

small, in the overall incidence of end-stage renal disease. The authors of the study suggest that while it is not completely clear as 

to the reasons for this, it does appear that greater access to diabetes medications may have impacted this change. 

The Cheyenne River Sioux used the Medicine Wheel nutrition 

intervention to demonstrate a positive trend in weight loss compared to the control group. 

Diabetes is not a solo actor. In order for us to truly define effective interventions, we must address all other variables that affect 

the rates of diabetes in our communities. 

33 

Access is a big issue. Access issues in relation to diabetes include, but are not limited to, distances traveled to healthcare facilities, availability of medications, health literacy, storage of medications, cultural literacy of the healthcare providers, and language 

barriers. 

My sister-in-law travels 1 hour and 15 minutes one-way, 5 days 

a week, for dialysis. My brother, who is a private contractor, takes 

her to her dialysis treatments. This impacts his ability to work and 

to provide for his family. One can understand the far reaching consequences that lack of access creates. 

Socio-economic. We cannot forget the variables of poverty, Western educational level, and occupation that contribute to the high 

rates of diabetes or any chronic disease. I have to tell the story of 

a patient of mine with diabetes, and this is not an uncommon scenario. His A1c level was 13, his blood pressure was 150/90, he 

weighed 300 pounds and he had a family to support. 

After several attempts at controlling his diabetes with our armamentarium, I asked him what was going on in his life. He stated, 

I have a family to feed. I fill my prescriptions, but instead of taking 

my medications as directed, I take them twice a week so that they 

will last longer. I cannot afford the healthy foods because they are 

more expensive. He recently suffered a stroke and is now in a nursing facility. 

Culture. Understanding the cultural perspective of diabetes is 

critical for successful interventions in reducing diabetes risk. Some 

studies suggest that Indian people may have a fatalistic view of diabetes, young American Indians and Alaska Native diabetics may 

have a different body image than the white population. We must 

understand those cultural variables. 

Public Health. The role of public health is critical and includes 

the development of tribal, state, national partnerships, partnered 

program planning, data collection and evaluation. All governmental 

agencies must include American Indian/Alaska Native data sets on 

diabetes. 

And if we think a little bit outside of the box, identifying measures that would reduce the risk of diabetes other than the pre-diabetes state is very important in addressing reduction of risk. The 

metabolic syndrome which assesses cardiovascular risk might actually be a better measure of diabetes risk than the fasting blood 

sugar. 

Overall planning for major changes in our society that impact 

physical activity is important. Examples that have impacted the 

physical activity, particularly in our youth, are the introduction of 

the television set. We did not plan for what outcome was going to 

be on that. We did not increase our physical activity recommendations. Taking physical activity out of our school curriculum, improved technology that results in a reduction in physical activity. 

And finally, nutrition. Policy makers must be aware that while 

the majority of society may have access to electricity and running 

water, American Indians and Alaska Natives do not necessarily 

enjoy these privileges. Without electricity, how do we store our insulin appropriately, how do we store healthy foods such as fresh 

vegetables, fruits, milk? In Indian Country, canned foods can be a 

staple because of the lack of electricity. 

34 

In closing, the approach to diabetes risk reduction is multi-factorial, but the key components still appear to be weight loss and exercise. This is the first time that our communities have success stories in making effective lifestyle changes by implementing interventions that have been developed by and for the communities. And 

that is key, that these interventions are developed by and for the 

communities. 

This is a new generation of health role models for our Indian 

children. Know that we can make the changes necessary in the battle against diabetes. In order for us to maintain and sustain this 

momentum that we are now seeing in our communities to address 

diabetes, we are confident that Congress will continue to support 

this effort. 

Thank you very much. 

[The prepared statement of Dr. McCabe follows:] 

PREPARED STATEMENT OF MELVINA MCCABE, M.D., PRESIDENT, ASSOCIATION OF

AMERICAN INDIAN PHYSICIANS

Introduction 

Chairman Dorgan, my name is Melvina McCabe, I am a Navajo physician working as an academician at the University of New Mexico School of Medicine Department of Family Medicine in Albuquerque, NM. I am also the current President of 

the Association of American Indian Physicians whose offices are based in Oklahoma 

City, Oklahoma. I am honored to testify today and grateful that you have invited 

me and grateful to the committee as a whole for considering the testimony. 

Diabetes is truly a crisis in Indian Country. The crisis is all-encompassing, affecting not only the physical health of our Indian Nations, but also impacting the mind 

and the spirit. As one of our own stated: ‘‘when the spirit is in pain, what does it 

matter if you take your medication or take a walk? ’’(1). I will present the statistical 

data and research findings and community intervention activities on diabetes in Indian country. 

Statistical Data 

According to CDC data, in 2005, the age-adjusted prevalence rate of diabetes in 

American Indians/Alaska Natives (AI/AN)was 16.5 percent compared to the non-Hispanic white rate of 6.6 percent and was highest for all underrepresented populations. Of note is the considerable geographic variation: Alaska Native adults with 

a rate of 6 percent and southern Arizona adults with a rate of 29.3 percent. AI/AN’s 

have the highest prevalence rate of diabetes in all age and gender categories compared to the white and other underrepresented populations. The IHS data on AI/ 

AN children and young people, between 1990–2009, reveals a 161 percent increase 

in Type 2 DM in those age <15. A significant risk factor for diabetes is obesity. AI/ 

AN youth, in particular, were more obese when compared to the U.S. general population (2). AI/AN with diabetes had higher rates of HTN, renal failure, lower-extremity amputations, and cardiovascular disease than the general U.S. population 

with diabetes (3). Diabetes and the coexisting morbidities continue to plague our AI/ 

AN people and, in particular, diabetes is now affecting those very dear to us, our 

children and young people. 

What Works 

The lifestyle interventions of weight loss and exercise remain the mainstay in diabetes prevention and cardiovascular risk reduction. For every kg of weight lost, 

there is a 16 percent decrease in diabetes risk. The development of new diabetes 

medications is not to be minimized, but lifestyle interventions are key. 

• The Diabetes Prevention Program bore out these key interventions (4). The 

study revealed a 58 percent reduction in diabetes incidence with the intensive 

lifestyle intervention group, a 31 percent reduction in the Metformin group compared to placebo. The interventions were exercise, weight loss, availability of a 

coach, and behavior modification. 

• A promising trend in diabetes outcomes is noted with the implementation of the 

Indian Health Service Special Diabetes Program for Indians. After 1998, community walking and running programs increased from 20 percent to 92 percent; 

35 

community exercise programs increased from 16 percent to 69 percent; school 

age physical activity programs increased from 9 percent to 69 percent; tribally 

defined interventions in reduction in TV watching increased from 25 to 35 percent, and weight management programs for children increased from 8 percent 

to 72 percent (5). The improvement in clinical interventions were a reduction 

of the A1C from 11 percent to 7.9 percent between 1996–2009, reduction in 

mean LDL cholesterol by 20 percent, and reduction in proteinuria by 32 percent. 

• The Journey to Native Youth Health project is a collaborative, community-based 

participatory approach partnership between the Montana Rocky Boy and Crow 

Indian reservations and the University of Montana for preventing risk factors 

associated with diabetes in Native youth, age 10–14 years old. The early findings from this study strongly suggests this intervention favorably impacts diabetes risk factors in Native youth by increasing moderate to vigorous activity 

and increasing caloric output compared to the control group (conversation with 

Blakely, PI; June 28, 2010)). Based on these findings, a full-scale trial has been 

submitted for funding and will be the first trial utilizing the DPP intervention 

specifically for Native Youth. Senator Tester, this would be exciting news for 

your state. 

• The Navajo Nation has adapted the DPP materials for use for Navajo people 

in their efforts to reduce diabetes. In addition, they have chosen to share with 

anyone their materials and have conducted training around the U.S. to implement this effective intervention. Senator McCain, your state needs to be congratulated for producing leaders in diabetes reduction efforts and who are willing to share their experience. 

• A relatively new medication is the incretin mimetics. Incretins have been shown 

to increase insulin secretion, but also increase satiety and weight loss. Another 

addition to our effective medication armamentarium. 

• The Pima Indians, since 1990, have experienced a decline in the overall incidence of end-stage renal disease. The authors of this study suggest that while 

it is not completely clear as to the reason(s) for this, it appears that greater 

access to diabetes medications may have impacted this change (6). 

• The Cheyenne River Sioux used the Medicine Wheel nutrition intervention to 

demonstrate a positive trend in weight loss and BMI compared to the control 

group (7). 

Other Considerations 

Diabetes is not a solo actor. In order for us to truly define effective interventions, 

we must address all other variables that affect the rates of diabetes in our communities. 

• Access: Decreased healthcare access has been identified as a factor contributing 

to the health disparities in our nation. Access issues in relation to diabetes include but are not limited to distance traveled to health care facilities, availability of medications, health literacy, storage of medications, cultural literacy 

of the healthcare providers, and language barriers. My sister-in-law travels one 

hour and 15 minutes, one-way, 5 days a week for dialysis; my brother, who is 

a private contractor, takes her to her dialysis treatments. This impacts his ability to work and to provide for his family. One can understand the far reaching 

consequences that lack of access creates. 

• Socio-economic: We cannot forget the variables of poverty, Western educational 

level, and occupation that contribute to the high rates of diabetes or any chronic 

disease. I have to tell the story of a patient of mine with diabetes and this is 

not an uncommon scenario. His A1C level was 13, his B/P was 150/90, he 

weighed 300 lbs, and he had a family to support. After several attempts at controlling his diabetes with our armamentarium, I asked him what was going on 

in his life. He stated ‘‘I have a family to feed’’. ‘‘I fill my prescriptions but instead of taking my medications as directed, I take them twice a week so that 

they will last longer’’. ‘‘I cannot afford the healthy foods because they are more 

expensive’’. He recently suffered a stroke and is now in a nursing facility. 

• Culture: Understanding the cultural perspective of diabetes is critical for successful interventions in reducing diabetes risk. Some studies suggest that Indian people may have a fatalistic view of diabetes, young AI/AN diabetics may 

have a different body image view than the white population. 

• Public Health: The role of public health is critical and includes the development 

of tribal/state/national partnerships, partnered program planning, data collecVerDate Nov 24 2008 10:52 Dec 03, 2010 Jkt 062518 PO 00000 Frm 00039 Fmt 6633 Sfmt 6621 S:\DOCS\62518.TXT JACK PsN: JACKF
36 

tion, and evaluation. All governmental agencies must include American Indian/ 

Alaska Native data sets on diabetes. 

• Outside the Box: Identifying measures that would reduce risk of diabetes other 

than the pre-diabetes state is very important in addressing reduction of risk. 

The metabolic syndrome which assesses cardiovascular risk might actually be 

a better measure of diabetes risk than the FBS. The measures are HDL, 

triglycerides, blood pressure, FBS, and waist circumference. 

Overall planning for major changes in our society that impact physical activity 

is important. Examples are: the introduction of the television set, taking physical activity out of school curricula, improved technology that results in a reduction in physical activity. 

• Nutrition: Policy makers must be aware that while the majority society may 

have access to electricity and running water, American Indians and Alaska Natives do not necessarily enjoy these privileges. Without electricity, how do we 

store our insulin appropriately, how do we store healthy foods such as fresh 

vegetables, fruits, eggs, milk. In Indian country, canned goods can be a staple 

because of the lack of electricity. 

In closing, the approach to diabetes risk reduction is multifactorial, but the key 

components still appear to be weight loss and exercise. This is the first time that 

our communities have success stories in making effective life-style changes by implementing interventions that have been developed by and for the communities. 

This is a new generation of health role models for our Indian children. Know that 

we can make the changes necessary in the battle against diabetes. In order for us 

to maintain and sustain this momentum that we are seeing now in our communities 

to address diabetes, we are confident that the Congress will continue to support this 

effort. 

References: 

1. Arpan J. Health for Native Life. (2002) 

2. http://www.ihs.gov/MedicalPrograms/MCH/M/bfdiabetes.cfm 

3. O’Connell J, etal. Diabetes Care. (2010) 

4. DPP 

5. Acton KJ. Am J Prev Med. (2009) 

6. Nelson RG. Diabetes Res Clin Pract. (2008) 

7. Kattelmann KK. J Am Diet Assoc. (2009) 

The CHAIRMAN. Dr. McCabe, thank you very much. 

And finally we will hear from Caitlin Baker, a 16-year-old 

Muscogee Creek Indian from Oklahoma. My understanding, 

Caitlin, is that your mother, Edith Baker, has accompanied you 

and is sitting behind you today. Is that correct? 

Ms. BAKER. Yes. 

The CHAIRMAN. Welcome to you. 

Ms. BAKER. Thank you. 

The CHAIRMAN. Caitlin, you may proceed. 

STATEMENT OF CAITLIN BAKER, MEMBER, MUSCOGEE CREEK 

NATION 

Ms. BAKER. I am Caitlin Baker. I am from Norman, Oklahoma. 

I am 16 years old and I am a member of the Muscogee Creek Nation. I have run my own outreach program for the last four years 

that works with Native American communities spreading the message that Type II Diabetes can be prevented through physical activity and healthy lifestyle choices, of course. 

I have traveled to communities across the Nation and my message is prevention. I feel that my generation has been raised with 

the continual message that diabetes is rampant in Native communities. My peers many times feel that Type II diabetes is inevitable. 

They tell me that they know they will get it eventually because 

their parents, grandparents and other family members may have 

diabetes already. 

37 

This feeling of inevitably can cause them to not take prevention 

seriously. This, in turn, affects the success of programs put in place 

to prevent diabetes. I feel that one major change that needs to be 

taken is the shift from inevitably to preventability. Stress to youth 

that diabetes is preventable. Inform them how to avoid diabetes. 

And then follow through by giving them the tools needed, like access to physical activity and healthier food options. 

I also stress to youth how important it is to use your voice and 

speak to leaders of your community. This does not include just 

health professionals, but also tribal leaders. Youth should go to 

their tribal leaders with what they feel that they need to make the 

healthy choices in their lives. Their voice is a powerful weapon. 

And I also ask their leaders to listen. Youth want to be heard and 

respected. 

I have been in communities where youth have asked for simple 

things like a say in their lunch menu, a soccer field, a pool, to have 

drinking and smoking banned in their public parks. This is what 

youth want. And involve your kids, and let them have ownership 

of the healthy changes being made in their communities. 

I once visited a jogging trail in Davenport, Oklahoma, which was 

the vision of local school kids in Davenport. The students decided 

they wanted one, so they raised the money and got the grants and 

they built it. When I saw it a year later, there was no trash and 

no graffiti. The local kids were proud of it and respected it. 

So, no offense to grownups, but I feel that if they had taken it 

over, they may still be figuring out how to build it and what to 

name it. 

[Laughter.] 

Ms. BAKER. So, I am not saying that grownups are not needed 

and they cannot get things done, but just that involving your youth 

is a positive thing. If you involve your youth, it makes them feel 

proud. Encourage them to be involved in planning and carrying out 

those plans. This will give them pride in themselves and in their 

communities. 

I also stress partnerships. I would not be able to do the work 

that I do without my partners. I hope that more organizations, 

both tribal and non-tribal, will work together. Diabetes prevention 

goes hand-in-hand with heart disease and tobacco control. The organizations working in these areas should be open to working together. 

Breathing problems and heart disease cause poor circulation, 

which in turn causes complications in diabetes patients. It seems 

that all of these areas should be working together to get the message across of prevention. And be aware of the work each other are 

doing. That way, nobody is duplicating the same programs so they 

share funding. 

Also, know your community. I have spoken with kids in New 

York, South Dakota, Oklahoma, Nebraska, New Mexico and Arizona, to name a few. Everywhere I go there is a different issue 

with their youth. The diabetes programs that I work with ask me 

to address prevention and physical activity, but also to tailor my 

message to what their community is struggling with. Each community is different. Take time to ask and figure out what these issues 

are. Do not approach this with a one answer for everyone attitude. 

38 

I do not mean, through my testimony, to give the impression that 

programs are not working. I can only speak about programs that 

I have been a part of and all of them have been positive experiences. My thoughts and ideas come from seeing the way that these 

programs work. 

So, in closing, many times people compliment me on the work 

that I do. I always appreciate words of encouragement, but I tell 

them that there are kids like me in every community. So, you 

should seek out those kids and encourage them. 

The topic today is the way out of the diabetes crisis in Indian 

Country. So, in my opinion, it is to involve every person in your 

community. Involve your youth and listen to them. We are living 

the crisis of diabetes and we do not want to live with diabetes forever. Let us work with you and find a way out of the crisis. 

Thank you, Chairman Dorgan, for letting me a part of your discussion and all of the Senate members who were not here. 

[The prepared statement of Ms. Baker follows:] 

PREPARED STATEMENT OF CAITLIN BAKER, MEMBER, MUSCOGEE CREEK NATION

Senate members my name is Caitlin Baker, I am 16 years old and live in Norman 

Oklahoma. I am a member of the Muscogee Creek nation. For the last 4 years I 

have run an outreach program that works with Native American communities 

spreading the message that diabetes can be prevented through physical activity and 

healthy lifestyle choices. I have traveled to communities across the nation. My message is prevention. I feel that my generation has been raised with the continual 

message that diabetes is rampant in Native communities. My peers many times feel 

that diabetes is inevitable. They tell me that they know they will get it eventually 

because their parents, grandparents and other family members have diabetes. This 

feeling of inevitability can cause them to not take prevention seriously. This in turn 

affects the success of programs put in place to prevent diabetes. I feel that one 

major change that needs to be made in the programs is a shift from inevitability 

to PREVENTABILITY. Stress to youth that diabetes is preventable. Inform them 

how to avoid diabetes and then follow through by giving them the tools needed like 

access to physical activity and healthier food options. Tell youth and communities 

what needs to be done to prevent diabetes and then work with them to provide what 

is needed. 

I stress to youth how important it is to use their voice and speak to the leaders 

of their communities. Not just health professionals who are working in diabetes prevention but also tribal leaders. Go to them with what they feel they need to make 

good lifestyle choices. Their voice is a powerful weapon. I also ask their leaders to 

listen. Youth want to be heard and respected. I have been in communities where 

youth have asked for simple things like a say in their lunch menus, a soccer field, 

a pool, to have drinking and smoking banned in their public parks. These are what 

youth want. Involve your kids; let them have ownership of healthy changes being 

made in their community. I once visited a jogging trail that was the vision of the 

local school kids in the small town of Davenport, Oklahoma. The students decided 

they wanted one so they raised money, got grants and built it. When I visited it 

a year later there was no trash, no graffiti. The local kids were proud of it and respected it. No offense to any grownups but I felt like if the adults had been handling 

it, they might still be discussing how to get it built and arguing what to name it. 

My point is not that adults aren’t needed or can’t get things done; just that including the youth is a positive thing. Encourage them to be involved in planning and 

carrying out those plans. This will give them pride in themselves and their communities. 

I also stress partnerships. I would not be able to do the work I do without my 

partners. I hope that more organizations, both tribal and non-tribal will work together. Diabetes prevention goes hand in hand with heart disease and tobacco control. The organizations working in these areas should be open to working together. 

Breathing problems and heart disease cause poor circulation, which in turn causes 

complications in diabetes patients. It seems that all these areas should be working 

together to get the message across of prevention and be aware of the work each 

other are doing. Share ideas and funding so that no one is duplicating programs. 

39 

Also, know your community. I have spoken with kids in New York, South Dakota, 

Oklahoma, Nebraska, New Mexico, and Arizona. Everywhere I go there is a different issue with their youth. The diabetes programs I work with ask me to address 

prevention and physical activity but also to tailor my message to what their community is struggling with. Each community is different, take time to ask and learn 

what issues there are. Don’t approach this with a one answer for everyone attitude. 

I don’t mean through my testimony to give the impression that programs aren’t 

working. I can only speak about programs I have been involved in and all have been 

positive experiences. My thoughts and ideas come from seeing the way those programs are working. 

In closing, many times people compliment me on the work I do. I always appreciate words of encouragement, but I also tell them that every community has kids 

like me. Find and encourage them. The topic today is ‘‘the way out of the diabetes 

crisis in Indian country.’’ In my opinion the best way out is to include all members 

of our communities. Ask and listen to your youth. We are living the crisis of diabetes. We don’t want to live with diabetes. Let us work with you to find a way out 

of the crisis. 

Thank you for inviting me today to join in your discussion. 

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The CHAIRMAN. Ms. Baker, thank you very much. 

Let me mention the reason for me being the only Senator because I think it is important. And by the way, let me also point 

out, you said that you were not suggesting grownups were not necessary. Without grownups, there would be no children. 

[Laughter.] 

The CHAIRMAN. But having said that, let me explain to you that 

this week is a rather unusual week in that our beloved colleague, 

Senator Byrd, passed away. His body will lie in state tomorrow in 

the Senate Chamber and there will be a funeral on Friday in West 

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Because tomorrow Senator Byrd’s body will lie in state in the 

Senate Chamber, there will be no Senate business. And so much 

of what was going to be done this week became truncated into 

today, Wednesday, virtually all of my colleagues are either chairing 

or participating in markups or hearings of Environment and Public 

Works and Energy and Judiciary and the Kagan hearings and so 

on. So, it created a difficult circumstance today. But your testimony 

is heard by all of the staff of the Committee Members who have 

participated today. 

So, I thank you very much for coming. I wanted to explain to you 

the special circumstances today. 

Let me ask some questions. Dr. Fradkin, what is the most positive thing you can tell me about work, at the NIH, in trying to cure 

diabetes? Because I hear, from time to time, or I see news reports 

that, this is the one disease that may be cured. We are so close 

here and there. 

Give me the strongest nugget that you can of what research, and 

what makes you believe that finally, perhaps, at long last we might 

be able to cure this disease. Or, does such information exist? 

Dr. FRADKIN. I was at the American Diabetes Association scientific sessions in Orlando and, just yesterday, the results of a very 

exciting trial were presented. This was a trial of sensor-augmented 

pump therapy for Type I Diabetes. 

What they showed was when people wore the continuous glucose 

monitors and had some communication but the data from that 

monitor was not being used to control the rate of delivery of the 

pump—it was not yet automated, the patient still had to make the 

changes—they got dramatic improvements in their hemoglobin A1c. 

That is the test that measures how good your control of diabetes 

is and which is associated with fewer complications. The patients 

had markedly fewer episodes of low blood sugar than we saw in the 

previous Diabetes Control and Complications Trial that proved that 

good control reduced complications. 

So, we are making huge progress toward this artificial pancreas 

that is one of the major goals of our special program funding. We 

still need to move further to actually link the two devices. When 

I told you that parents could sleep through the night, what I meant 

is that they do not have to set their alarms to wake up to test their 

children. But that does not mean they are still sleeping through 

the night because the sensors are going off and sounding alarms 

when the sugar is not normal. 

What we want is for the sensor to be able to directly control the 

delivery of insulin, to take the burden off of these finger pricks that 

kids are doing every hour. We want kids to be able to forget for 

awhile that they have Type I Diabetes and live a normal, carefree 

childhood. 

And I think if we can make progress in what we call closing that 

loop, that is tremendously encouraging. And I can give you some 

similar examples with regard to Type II Diabetes. 

The CHAIRMAN. But you are talking about, particularly, advances 

in monitoring. Which is so very important, no question about that, 

because that deals with the health and mortality of the patient. 

I am asking about things that you see that suggest, because of 

changes in research and capability. The first owner’s manual for 

53 

the human body exists now with the genome projects and so on. Is 

there a body of research out there that gives you hope that perhaps 

10 years from now you might testify somewhere and say well, in 

this area, we were able to actually cure or reverse? Tell me your 

assessment of that, as opposed to just monitoring. 

Dr. FRADKIN. I told you about this TEDDY trial where we have 

just finished the recruitment. We have found 8,000 children who 

are at very high genetic risk for Type I Diabetes. We are monitoring them, looking at their diet, looking at blood samples which 

are going to be looked at with incredible new technologies that 

have come out of the genome project, and, for example, if we could 

find an infectious trigger through these samples, we are going to 

analyze the kids who are at high genetic risk who did and did not 

get Type I Diabetes. 

If we could find an infectious trigger or some aspect of the diet, 

we know something is happening in the environment that is causing Type I Diabetes because rates are going up by several percent 

per year. If we could find an infectious cause and have a vaccine 

that could prevent Type I Diabetes, that is what we are aiming for. 

So, at every step along the disease, we are trying to make improvements in the care for people who have diabetes, and we are 

trying to prevent diabetes. 

The CHAIRMAN. Thank you. 

Dr. McCabe, some in the audience may not know from the reference of a physician the difference between Type I and Type II Diabetes. Would you describe that? 

Dr. MCCABE. Yes. Type I Diabetes is a state where there is a 

lack of insulin production. Type II Diabetes, there are a couple of 

things that are going on. One is, most likely, insulin resistance, 

and a decrease in the secretion in insulin production. 

The CHAIRMAN. I am going to ask some additional questions with 

your practice. 

Mr. Hall, when you were diagnosed with Type I Diabetes, you 

talked about being devastated, did not know what this means, and 

so on, and then decided to proceed, nonetheless, to resume swimming, continue training, and won. I think you said, six additional 

medals, after that diagnoses. 

What impact did Type I Diabetes and the treatment and the lifestyle changes you had to make have on your ability to maintain 

that level as a world class swimmer? 

Mr. HALL. Diabetes management is an additional step that none 

of the competitors that I raced against had to contend with. It is 

through that shared experience with the rest of the diabetes community that I am able to express my empathy with those that are 

diagnosed and living with this disease. It is sincere and appreciated. 

The challenges of managing diabetes are extreme. When diabetes 

nurse educators are talking to a newly-diagnosed patient, they will 

show them a picture of me with a gold medal and say this is possible. But the picture that they do not share with those patients 

is me helpless with a hypoglycemic reaction calling out for help and 

some orange juice. And that happens a lot more frequently than 

winning a gold medal. 

54 

The challenges are real. In Imperial China, death by a thousand 

cuts was a form of torture and death. I sometimes feel that diabetes is death by thousands and thousands of injections and finger 

pricks. And I think that sums up some of the feelings that are 

shared by a lot of people that are required to live with this every 

day without any break from diabetes. 

The CHAIRMAN. In some ways, the dilemma here is that you look 

like the picture of health, and yet, you have a very serious illness. 

And I have seen the other picture. I have gone to Indian reservations and I have seen people sitting in dialysis units. I have seen 

people walk on crutches because they had a leg amputated. And I 

understand almost instantly, even if I do not talk to the person, 

what the circumstances are of that amputation. The background is 

diabetes. 

And so, you look like the picture of health, and yet you have 

Type I Diabetes. I suspect that the two physicians here kind of confront those realities in the practice. They can see an Olympic swimmer winning medals with Type I Diabetes and so it is not so bad, 

it is manageable. And yet you described that even now your management of your disease is a 24 hour a day management. Is that 

correct? 

Mr. HALL. That is correct. That is correct. And I am example 

that diabetes is an epidemic, that diabetes knows no boundaries of 

race or border. 

The CHAIRMAN. Dr. McCabe, tell me about your practice. What 

percent of your patients have diabetes? 

Dr. MCCABE. By describing my practice, you will get an idea of 

what percent have diabetes. I was trained in family medicine. I did 

a two-year fellowship in geriatrics. So, my practice, mainly, is geriatrics. So, a high percentage of my patients have diabetes. 

The CHAIRMAN. And what percentage of your patients have had 

access to adequate screenings so that they could detect this diabetes as early as is possible and begin to manage it? 

Dr. MCCABE. I would like to say 100 percent, but I know that 

is not the case. I know that is not the case. In this Country, we 

do not do as well in screening as we really need to. 

The CHAIRMAN. Especially on the Indian reservations, it seems 

to me. 

Dr. MCCABE. Exactly. 

The CHAIRMAN. One of the keys, as I have seen it is, in addition 

to treatment, on Indian reservations, front end screening to try to 

identify those that have this disease, and then move them into 

treatment. But the lack of screening, and the lack of understanding 

that if someone is not feeling well and they have certain symptoms 

and so on, they never get the diagnosis, look, here is the problem 

and here is the way to manage it. I think screening is critically important. 

Dr. MCCABE. And I think the Indian Health Service is making 

great efforts and improving the quality of healthcare on the diabetes front and that includes identifying diabetes early. I alluded in 

my statement earlier that the fasting blood sugar may not be the 

only way now to really identify someone who is at high risk. I talk 

about the metabolic syndrome and if we can use some of those criteria, we may be able also to identify a little bit earlier. 

55 

The CHAIRMAN. Mr. Studi, my understanding is that you, earlier 

this year, were involved in efforts to encourage Native Americans 

to get the flu vaccine, encouraging those infected with the flu to 

take prescribed medicine and so on. Have you been involved in that 

kind of activity? 

Mr. STUDI. Yes. Earlier this year, we made some PSAs for encouraging Native Americans to get their shots for what was called 

the Swine Flu and I think they were, to some extent, effective. 

The CHAIRMAN. In many ways, that approach, in your case dealing with the flu and the encouragement to get the vaccine, it relates to the question of, how difficult is it to get Native Americans 

to be able to, number one, acquire the medicine necessary to manage a disease like diabetes, and then to make sure they take that 

medicine. 

I think it was Dr. McCabe who described someone who said well, 

I buy the medicine but I take it only twice a week in order to afford 

it. And, of course, that has a very serious health consequence. 

So, when I saw that you had done some PSAs on, get our vaccine, get vaccinated, take the medicine, that is also a part and I 

would guess that both doctors believe, that is a part of what we 

have to do with respect to treatment of this disease called diabetes. 

Mr. STUDI. Oh, absolutely. Prevention is the whole thing that we 

going after. And I did it somewhat reluctantly because the vaccine 

was not being made as available as it possibly could be at that 

time. And so, while I was working with some people who were very 

enthusiastic about doing this, I was somewhat reluctant, and I had 

also heard that it was difficult to find the amount and the type of 

shots that were supposed to be made available. But, fortunately, I 

was wrong as time went on and this was, the shots were made 

available as time went on. 

But you do have to take into consideration that areas are not, 

areas where you can get your shots and that kind of thing are not 

as easily accessible for all people. And I am talking about large reservations where people have to travel long distances to clinics and 

that kind of thing. 

In the long run, yes. These things are definitely tied around prevention, and prevention has to do with lifestyle, and that is what 

I attempt to advocate. 

The CHAIRMAN. Yes, I think it is the case on a broader point that 

those who were here first, the First Americans, really, are getting 

second class healthcare in this Country, in terms of what was 

promised to them. The delivery, by treaties that were signed saying 

we will provide you healthcare, that trust responsibility in which 

the Government promised, the Government simply has not met 

those obligations. This is why we have worked very hard to pass 

the Indian Health Care Improvement Act. I am proud to say that 

is now law of just a couple of months. 

Caitlin Baker, you talk about outreach and the organization that 

you have created to do outreach with young people. I am assuming 

that you probably, talk about lifestyle and those things. I hope you 

are talking about teen suicide, broken families, and drug use, all 

of the things that confront young people. 

56 

I have gone to reservations and sat, just myself as the only adult 

with a roundtable of kids, just to talk to them about their lives. 

And they face plenty of challenges, as you know. 

But this issue of diabetes I assume is on the minds of every 

young Native American because they see their aunt, their uncle, 

their mom, their dad, grandpa, grandma fighting this disease, perhaps going to the dialysis center, going through treatment. 

Give me your assessment. What are young people thinking about 

with respect to diabetes and are they pretty acutely aware of the 

potential of diabetes in their lives? 

Ms. BAKER. Well, most people my age are, and a lot of my peers 

that I work with, they all know diabetes because, you know, grandma has it, auntie has it, somebody in their family will have it. My 

grandmother has diabetes and she is 90. She is really old. But 

there are a lot of people who are much younger who have diabetes 

as well. 

A good of friend of mine, he would pour tons of sugar in his tea, 

and I would look at him and be like, what are you doing? I mean, 

he is Native as well. So, you know, try to encourage good lifestyle. 

But, you know, he is talking about, you know, I feel like I am going 

to get it anyway because my mother has it. Both of his parents 

have it. 

So, I feel like sometimes doctors, not all doctors, but sometimes 

they will tell him, you know, you are more likely to get it because 

your parents have it or your grandparents have it. So, I feel that 

a lot of people my age, especially Native youth, feel that they may 

get it. 

Younger kids, though, I think they are more educated in diabetes 

starting now. The CDC comes out with the Eagle books which are 

a series of children’s books for second grade and below that introduce diabetes at a very young age at a level that they can understand it. And talking about healthy living. So, in that way, it is a 

good education to have for these kids. 

The CHAIRMAN. You do not have diabetes as I understand it. 

Ms. BAKER. No. 

The CHAIRMAN. What made you decide to form the organization 

that you formed and to do the kind of outreach with young people 

about these issues? 

Ms. BAKER. Well, when I was 12, I went to the North American 

Indigenous Games for swimming. I was the only swimmer from 

Oklahoma. And part of being on a swim team, you might know, is 

having members, a relay, you know, a support system there for 

you. And so, this whole program started with me recruiting more 

swimmers that were Native to go on the next games with me, 

which we ended up not going because, well, I do not know why. 

So, that is kind of where this all started. The more I got involved 

with it, the more people that I met, I started seeing more issues, 

suicide, teen pregnancy was a big issue that I worked with, let’s 

see, diabetes, of course, and of course, having access to pools. 

I worked a lot with having pools accessible because I worked 

with the Olympic Committee and Native Americans are the second 

highest drowning rates in the nation. So, I worked a lot with getting pools built, starting clinics, doing some clinics. I did some clinVerDate Nov 24 2008 10:52 Dec 03, 2010 Jkt 062518 PO 00000 Frm 00060 Fmt 6633 Sfmt 6601 S:\DOCS\62518.TXT JACK PsN: JACKF
57 

ics with Josh Davis and Mark Spitz before, and they are two great 

swimmers that I got to work with. 

But, you know, just programs like that kind of implicating 

healthy lifestyles which swimming, I feel, is a very family-oriented 

sport. 

The CHAIRMAN. Are you a competitive swimmer now? 

Ms. BAKER. Yes, I am. 

The CHAIRMAN. Do you consider Gary Hall an old man? 

[Laughter.] 

The CHAIRMAN. The reason I ask the question, without trying to 

make fun here, is you described your grandma as real old at 90. 

Ms. BAKER. She is 90. 

[Laughter.] 

Ms. BAKER. I do not think there is anybody who is 90 in here. 

[Laughter.] 

The CHAIRMAN. Let me also, I kind of grinned when you referred, 

obliquely, to the fact that I was the only Senator here. All of the 

adults recognized that but decided not to say anything about it. 

[Laughter.] 

The CHAIRMAN. But, at age 16, you have the license to do that. 

[Laugher.] 

The CHAIRMAN. I would warn you not to go over to the Floor of 

the Senate today because, if you get to the gallery and look down 

onto the Floor of the Senate, you will see a Senator perhaps speaking with great passion and no one else in the room. And you, probably will, want to observe that when you get back home as well. 

[Laughter.] 

The CHAIRMAN. Your work inspires me and I think you will make 

a difference in people’s lives and I appreciate what you do. 

Let me ask, if I might, Izzy, would you be willing, if we brought 

a chair next to Mr. Hall, to come forward just for a moment? Would 

you do that? We will just pull up a chair next to Mr. Hall there. 

And I want to ask Mr. Hall another question as well at some point. 

Izzy, you are 16 years old, 16. Is that right? 

Ms. BURGER. No. 

The CHAIRMAN. Oh, that is Caitlin. You are how old? 

Ms. BURGER. I am 11. 

The CHAIRMAN. Eleven. I should have known that. You probably 

think Caitlin is real old. 

[Laughter.] 

Ms. BURGER. Not really. I have some sisters older than her. 

The CHAIRMAN. You heard the testimony from Gary Hall, a remarkable athlete and swimmer and Olympic champion. You are a 

young woman, a young girl who has been diagnosed with diabetes. 

Tell me about what you do to manage this disease. How does the 

disease affect your life? 

STATEMENT OF ISABEL ‘‘IZZY’’ BURGER, MEMBER, LITTLE 

RIVER BAND OF OTTAWA INDIANS 

Ms. BURGER. Well, I like to play a lot of sports like basketball 

and softball. And I like to go fishing. And sometimes if my blood 

sugar is too high, I am forced to do those things, which I am fine 

with. But if it is too low, I cannot do those things, like maybe at 

a time when I want to do those things with friends. 

58 

So, I have to kind of manage it well because, if I do not, sometimes I kind of do not have privileges of something that normal 

kids would be able to do whenever they want. 

The CHAIRMAN. Do you have to be attentive every day, all day, 

to this disease? 

Ms. BURGER. Pretty much, because if I start to feel not normal, 

like if I start to feel really thirsty or really tired, then I have to 

realize that and check my blood sugar and fix it if there is a problem. 

The CHAIRMAN. How many children are in your class at school? 

The reason I am going to ask the question is, are there others who 

have diabetes? Do you have friends who have diabetes that have 

to manage their disease and so you talk together about it? 

Ms. BURGER. Not really. I am the only one. 

The CHAIRMAN. So, where did you get the information with which 

to manage your disease? 

Ms. BURGER. When I was first diagnosed, my doctor was really 

good with it. I went to DeVos Children’s Hospital in Grand Rapids. 

And she was very good at describing the disease at a level that I 

could understand. 

The CHAIRMAN. Do you have relatives that have diabetes? 

Ms. BURGER. Yes. My grandmother has Type II Diabetes and she 

kind of helped me with it, like described how to bring it down if 

it was too high and things like that. 

The CHAIRMAN. Well, you are a very poised young woman. Do 

you want to introduce your mom? 

Ms. BURGER. Yes, my mom is right there. 

[Laugher.] 

Ms. BURGER. Her name is Jessica Burger and she is really good 

with it. She helps me a lot. 

The CHAIRMAN. We appreciate your being here and thanks for 

letting me ask you to come up and say a word. I appreciate that. 

Ms. BURGER. Thank you for having me. 

The CHAIRMAN. Gary, I am going to ask a couple of other questions of the witnesses. 

As you know, we are trying to get the legislation on the Special 

Diabetes Program. We are also trying to pump more money into 

the National Institutes of Health. At one point we wanted a program to double the NIH funding, which we did. There were about 

6 or 7 of us in the Senate particularly that took it under our wing 

and decided that we really ought to put a lot more money into research because it pays very big dividends. 

Now we are trying to keep up with the rate of inflation because 

we have less money and we have fiscal policy problems. 

But I remain convinced that the search needs to be number one, 

to better monitor, and that relates to some technology with monitoring devices and so on, but especially, most especially, to keep 

pursuing very aggressively to find a cure. 

Dr. Fradkin, when we provide money to the NIH, to virtually any 

institute, that money goes out all across the Country in trials and 

various approaches. Tell me, what is happening to the money for 

diabetes at the NIH? Just give me a description, generally speaking, where does all that go, how is it invested, and for what purpose? 

59 

Dr. FRADKIN. One program that you might be very interested in 

because of your interest in a cure is our Beta Cell Biology Consortium. That is a group of scientists around the Country, and even 

internationally, that are trying to find ways to re-grow the beta 

cells, the insulin-producing beta cells, in people who have Type I 

Diabetes, either to convert other cells in the body to insulin-producing beta cells or to find a stem cell within the body that could 

be stimulated to grow into a beta cell, or to take stem cells from 

outside the body, convert them into beta cells, and then administer 

them. 

That is an approach to the cure that is going on across the Country and even internationally with the support of the Type I money. 

The CHAIRMAN. So, most of that is in the stem cell research area? 

Dr. FRADKIN. It is stem cells, both taking stem cells that are 

being studied in the test tube to try to create beta cells, but also 

trying to figure out ways to find the stem cells within a person’s 

own body that might be stimulated to re-grow in somebody who 

has lost their beta cells. 

The CHAIRMAN. And is there any evidence, or any early evidence, 

whether embryonic stem cell research or some other research, is 

better suited to finding a cure? 

Dr. FRADKIN. Sir, we have made tremendous progress in this 

area. We now are able to take embryonic stem cells and we have 

identified the various genes that need to be turned on to move one 

of those cells toward an insulin-producing cell and we can get all 

the way toward making one of those cells make insulin. 

The next stage though, there are a couple of different problems 

that we need to overcome to make this a cure. One is to modulate 

the immune system so that even if we create a new beta cell and 

either give it to people or they grow their own beta cells, that it 

will not be destroyed by the immune system. And the other thing 

is that even though we have gotten to the point where those cells 

can make insulin, we need to get them to make insulin in the exquisitely-regulated way in which tiny changes in glucose modulate 

the production of insulin. 

So, we have a number of next steps to take. But I think that is 

an example of the kind of consortia that we create. 

Most of the funding, about two-thirds of the funding, is spent directly by NIDDK, which manages the funding, and most of that is 

going to large, multi-site consortia that involve sites across the 

Country. So, for example, our clinical trials network includes a 

whole network of hundreds of sites to enroll people all over the 

Country in efforts to prevent or to treat newly-diagnosed Type I Diabetes. 

We also use the funds through other components of NIH. For example, the trial that showed these very promising effects on eye 

disease was conducted by the National Eye Institute. We provide 

money to the Centers for Disease Control to monitor the epidemic 

and to develop standardization of the A1c that I mentioned. So, the 

funds are very, very broadly distributed. 

The CHAIRMAN. All right. 

Mr. Studi, the issue of traditional culture and practice on Indian 

reservations. Have you observed how that might or might not play 

a role in both detection and treatment of diabetes? 

60 

Mr. STUDI. Well, as a matter of fact, I think the real disaster of 

the whole thing is that it is so accepted as a part of life. Diabetes 

is like, as the young lady mentioned, it is like everybody has it, 

somebody has it here or there, relatives and friends. It is practically accepted to the point of, well, there is really nothing we can 

do about it, you know? It is just a fact of life. It is something that 

we have to live with. 

Well, I think that part of SDP’s goal is in educating the public 

to the point, or the Indian public, to where I speak, you know, that 

there is cause to be glad that there is somebody working towards 

a cure for this, as well as the development of more treatments and 

research that is going on. 

The educational arm of the whole thing is that we need to get 

the idea out that no, it is not an acceptable thing. It is just another 

epidemic that has scourged Indian Country since the beginning of 

our cultures coming together. 

The CHAIRMAN. Mr. Hall, how old are you? 

Mr. HALL. I am 35. 

The CHAIRMAN. So, your Olympic competitive swimming career is 

likely over. 

Mr. HALL. That is true. 

[Laughter.] 

The CHAIRMAN. Maybe I should not have declared that, I should 

have let you answer that. 

[Laughter.] 

The CHAIRMAN. But you will remain, I assume, someone who is 

fit and athletic and you will exercise so you will always probably 

have to manage this disease in the context of training and exercise. 

Tell me just a bit about the organization that you created. As I understand it, you created an organization with respect to outreach 

and information with respect to diabetes. Is that correct? 

Mr. HALL. Well, I am involved with several nationwide programs, 

one through the United States Olympic Committee that is encouraging schools to measure the distance and encourage walking 

among students, where it is a measured every six weeks program, 

World Fit is the name of that program. 

And also just in trying to create general diabetes awareness. I 

have been involved with makeover programs. Yes, happiness is not 

possible without health. 

The CHAIRMAN. Have you had a chance to, an opportunity, to go 

to some Indian reservations to talk about diabetes? 

Mr. HALL. I spent many years in Arizona and was familiar, early 

on, with the problems, even prior to my diagnosis with diabetes, 

with the Pima Indian population and their struggles with diabetes. 

The CHAIRMAN. Well, thanks for your work. Some people would 

just get a bad diagnosis and do everything they could to address 

it themselves, overcome it themselves and that is it. But you have 

done much, much more than that and I appreciate very much your 

willingness. 

Mr. HALL. Thank you for saying that. The inspiration that I have 

been honored to offer to people with diabetes is so small compared 

to the hope that the Special Diabetes Program research offers to 

the diabetes population. The research is promising and any lapse 

61 

in funding would disrupt that important research that provides 

hope to all of us. 

The CHAIRMAN. Thank you very much. 

Dr. McCabe, one of the things that has come up in a couple of 

pieces of testimony today is that television is a pretty awful competitor for exercise. And, you know the desire to get young people, 

particularly young people, off of the chair from watching television 

and out into the yard exercising is a critical part. Particularly for 

those who have the disease diabetes, it is a critical part in managing it. Is that correct? 

Dr. MCCABE. Absolutely. 

The CHAIRMAN. So, are you going to take care of the television 

problem? 

Dr. MCCABE. Absolutely. 

[Laughter.] 

Dr. MCCABE. No, it truly is. And again, as I alluded to, I think 

when we have introductions of new technology that are introduced 

into this Country, concomitant with that we have to see what the 

impact is going to be. And for television itself, it has been on increased rates of, I think, diabetes, because there is decreased physical activity associated with that. 

So, that is the future planning. That is the long-range planning 

that we must begin. And it is not only for American Indians and 

Alaska Natives. It is for the whole Country. Our rates of diabetes 

for this whole Country are high. 

The CHAIRMAN. It is important to say again. We are holding this 

hearing in the Indian Affairs Committee, but this is a national epidemic. There is no question about that. And it is growing very rapidly and has to be addressed. 

But, the epidemic is especially acute, much more so than the national statistics, on Indian reservations many of which are in remote areas, many, many, many miles from other healthcare facilities. And that makes it very difficult because we have had to try 

to see if we could put dialysis units and detection and treatment 

centers in very rural areas. 

I cannot tell you the number of people I have talked to who had 

to go 80 miles one-way for a dialysis treatment on a remote Indian 

reservation, to be put on a bus and taken some place. And those 

are the lucky ones that get taken there. Others that do not get diagnosis quickly enough and lose limbs and lose their sight. It is 

such an awful disease. It ravages the body throughout the life of 

the patient. 

Caitlin, let me again say that I think it is really inspiring and 

special in my life when I meet somebody who is really young, and 

by that I mean a teenager or less even, somebody who is really 

young who is doing interesting things in working outside of themselves and wanting to become a part of something bigger than 

themselves. 

Ms. BAKER. Thank you. 

The CHAIRMAN. You will make a difference and you will, I think, 

save lives and help other Indian children. So, I appreciate the work 

you do. 

Ms. BAKER. Thank you. 

62 

The CHAIRMAN. Let me thank all of you. This Committee, as I 

indicated, we were able to get the Indian Healthcare Improvement 

Act passed after, I believe it was 18 years since when it was last 

addressed. We able to get that signed into law by the President 

this year. 

We just in recent days, last week in fact, Thursday night, were 

able to get passed the Tribal Law and Order Act, which is unbelievably unimportant. We have rates of violent crimes on some Indian reservations that are 5 and 10 and 12 times the national average. It is very hard to live with any sort of confidence or hope for 

the future if you do not feel safe. 

And so, we are going to get the Indian Health Care Improvement 

Act implemented. We are going to get the Tribal Law and Order 

Act done in this Congress. And we are going to push very hard to 

get the Special Diabetes Program reauthorized. That is a priority 

for this Committee. 

And the willingness of the five of you to travel some distance to 

come and testify today is very much appreciated. We thank you 

very much. 

This hearing is adjourned. 

[Whereupon, at 11:12 a.m., the Committee was adjourned.] 

(63) 

A P P E N D I X 

PREPARED STATEMENT OF THE NATIONAL INDIAN HEALTH BOARD


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