An innovative community-based diabetes prevention program developed here, which has demonstrated its effectiveness among inner-city African Americans, is now being modified by American Indians for use on a remote southern Arizona reservation with one of the world's highest diabetes rates.
Studies have shown that the rate of non-insulin dependent diabetes mellitus (NIDDM) among Indians of the Tohono O'odham Nation is six times higher than in the general population of the United States. The reservation has the highest mortality rate from the disease of any area served by the Indian Health Service, 40 percent of tribe members over 35 have diabetes, and as many as 10 percent of the tribe's members have had lower extremities amputated because of complications from the disease.
Five Tohono O'odham women came to campus in November as part of a pilot demonstration project that will recruit and train members of the tribal community to develop their own program to prevent diabetes. The tribal council unanimously approved the program, which stresses education about exercise and better nutrition.
Wendy Auslander, Ph.D., associate professor of social work and a longtime diabetes prevention researcher, is the principal investigator for the project. She has worked closely with Eddie Brown, director of the George Warren Brown School of Social Work's Kathryn M. Buder Center for American Indian Studies, to develop liaisons with the Tohono O'odham community. The project is funded by a grant from the National Institutes of Health to the Diabetes and Research Training Center at the School of Medicine.
Part of the problem in developing a prevention program for the Tohono O'odham, said Auslander, is that the 10,000 members of the tribe living on its four reservation areas are scattered over nearly 3 million acres of desert and mountains. In addition, more than 60 percent of the reservation's residents live below the poverty level and 23.4 percent of them are unemployed.
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"We saw a need to educate our people about diabetes," said Shirley Manuel, a representative of the Hickawan District of the Tohono O'odham reservation, which is located south of Phoenix and west of Tucson. "We need to fight this diabetes. I don't want my people to give up to this disease."
As with the African- American-oriented program in St. Louis, the American Indian project helps community members to learn new, more nutritious methods of preparing traditional foods and to spread word of these techniques among friends and family. Both programs couple the skills of diabetes and nutrition experts in the School of Medicine with the community outreach and social services expertise of the social work school.
There is already a diabetes screening program in place on the reservation, but Cynthia Lopez, health educator for the tribe's Department of Human Services, said it lacks the resources it needs to be effective.
"It's a big problem out there," said Lopez, who is encouraged by the Washington University initiative. "I think we'll get a lot of support."
Officials believe that genetic markers, dietary patterns, obesity and sedentary lifestyles are responsible for the near epidemic rates of NIDDM among American Indians. Obesity, diet and exercise have been targeted as factors that can be changed and controlled to prevent or at least delay the onset of diabetes and, once it has set in, to reduce its complications.
Researchers point to changes in the lifestyles of tribe members -- a move away from traditional foods and activities -- as part of the problem.
"Our people used to eat a lot of vegetables and beans," said Lopez. But then came electricity and refrigerators "and ice cream and chips."
Plans call for the core group of five tribal members who attended the organizational sessions on campus to recruit and train more volunteers from the reservation. They will in turn set up programs in each of the Hickawan District's seven villages to educate their residents, screen them for diabetes and motivate them to exercise. They also hope to teach them to cook healthier foods and encourage them to revert to a more traditional, active lifestyle.
Brown, a registered member of the Pascua Yaqui-Tohono O'odham tribes in Arizona, is a co-director of the reservation's diabetes prevention program. He also is a former assistant secretary of Indian affairs under President George Bush.
"Many people get involved in working with Indian communities who have very little faith in the people," Brown said, "but I've seen that people and communities can change."
Because many residents live in remote areas, getting the word out will not always be easy. "Sometimes we will have to go door to door to explain it all," Lopez said.
The job is, admittedly, a massive one, Brown acknowledged. But if it is successful, it can be duplicated in the tribe's other 10 districts and possibly exported to other reservations.
"The NIH grant ends in five years," Auslander said, "but the resources will stay in the community. We want the reservation to develop its own capacity to deal with the problem in the future."
