The Centers for Disease Control and Prevention (CDC) announced in early January at a press conference attended via phone by The Seminole Tribune that diabetes-related chronic kidney disease among Native Americans and Alaska Natives has reached a remarkable low.
According to the CDC’s latest Vital Signs – Diabetes report, cases of chronic kidney disease (kidney failure) related to diabetes have decreased by 54 percent since 1996. The statistic, released Jan. 11, was based on records through 2013.
CDC Director Tom Frieden credited the dramatic decrease to approaches implemented by Indian Health Services (IHS), an agency of the U.S. Department of Health and Human Services. Diabetes is more prevalent among Native Americans than among any other population in the U.S. One out of three Native Americans with kidney failure get the often fatal condition from diabetes.
“The IHS applied population health and team-based approaches to diabetes and kidney care, which reduced kidney failure rates much faster among Native Americans than among any other race of ethnic group in this country,” Frieden said.
Mary Smith, principal director of the IHS, said the agency provides care to 2.2 million Native Americans throughout the U.S. with the intent to raise the people’s physical, mental, social and spiritual health. The 54 percent drop includes all Native Americans and Alaskan Natives, which according to U.S. Census data includes roughly 4.4 million people.
Smith, a member of the Cherokee Nation, said the drop in diabetes-related kidney failure is good news not only for Natives but for all ethnicities. She noted the 1979 launch of the National Diabetes Program of which the IHS developed the first diabetes standards of care for Natives in 1986, which promoted evidence-based treatments and led to a series of updates spanning the 1990s.
Additionally, Congress established the Special Diabetes Program for Indians (SDPI) through the Balanced Budget Act of 1997. The SDPI is a $150 million per year program that provides grants for diabetes treatment and prevention services to 404 IHS tribal and urban Indian health programs. The SDPI has two major components: the Diabetes Prevention and Healthy Heart Initiatives and the Community-Directed Diabetes Programs.
In 2016, according to an April 2016 IHS press release, the program provided approximately $138 million in grants to prevent and treat diabetes among Native people. Grant funds went to 301 Tribes, Tribal organizations, urban Indian organizations and IHS facilities.
Ann Bullock, director of the Division of Diabetes Treatment and Prevention, Indian Health Services, said nearly 99 percent of Native Americans who have diabetes have Type 2 diabetes compared to Type 1.
According to the National Institutes of Health, Type 2 diabetes is primarily caused by lack of exercise, obesity and poor diet — though genetics can also play a role. Type 1 is attributed mostly to genetic or environmental factors.
Regarding the decrease in kidney failure among Natives with diabetics, Bullock said: “We never want to forget to acknowledge the efforts of our patients. Partly though patient education that our IHS, tribal and urban partners have been doing so many years . . . our patients have made remarkable efforts overcoming huge obstacles and barriers of care.”
Smith said increased program availability via diabetes clinical teams had jumped from 30 percent in1997 to 96 percent in 2013 alone while adult weight management programs increased from 19 percent to 78 percent during the same time period. The effort allowed Tribal employees time off for diabetes education and exercise. All Tribal members were provided with better access to healthier foods, transportation to clinics, and classes in diabetes and exercise.
“Management of risk factors or kidney failure have improved, including use of medicine to protect kidneys, controlling high blood pressure and controlling blood sugar,” Smith said.
Recommendations from SPDI studies, some already being put to work by IHS, are expected to impact future generations. IHS is already catching at-risk patients earlier, providing them with treatment before the onset of diabetes, she said.
“This results in better health for our patients and a significant cost savings as compared to long-term diabetes treatment,” Smith said.
Nationwide in 2013 alone, kidney failure from diabetes came with a price tag of $82,000 per person while Medicare kicked in $14 billion to treat the disease combination.
Here are some important improvements since the IHS began focusing on diabetes-related kidney care:
* Use of medicine to protect the kidneys nearly doubled from 42 percent to 74 percent within five years. Among patients ages 65 and older with diabetes, 76 percent were treated with kidney protecting medicines.
* In 2016, blood pressure was better controlled — about 68 percent of Native Americans with diabetes met targeted blood pressures of equal of lower than 140/90.
* Blood pressure improved with a 10 percent decrease in blood sugar levels within five years.
* In 2015, more than 60 percent of people ages 65 and older had taken the recommended urine tests for kidney damage.