Diabetes and American Indian and Alaska Native Women

What is diabetes?
Is diabetes a health problem for American Indian/Alaska Native (AI/AN) women?
Are many AI/AN women dying because of diabetes?
Why are AI/AN women so susceptible to diabetes?
How does diabetes affect AI/AN women during pregnancy?
What other complications of diabetes exist in AI/AN women?
How can AI/AN women manage diabetes?

What is diabetes?

Diabetes is a disorder of metabolism---the way our bodies use digested food for growth and energy. Most of the food we eat is broken down by the digestive juices into a simple sugar called glucose. Glucose is the main source of fuel for the body. After digestion, the glucose passes into our bloodstream where it is available for body cells to use for growth and energy. For the glucose to get into the cells, insulin must be present. Insulin is a hormone produced by the pancreas, a large gland behind the stomach.

When we eat, the pancreas is supposed to automatically produce the right amount of insulin to move the glucose from our blood into our cells. In people with diabetes, however, the pancreas either produces little or no insulin, or the body cells do not respond to the insulin that is produced. As a result, glucose builds up in the blood, overflows into the urine, and passes out of the body. Thus, the body loses its main source of fuel even though the blood contains large amounts of glucose.

Is diabetes a health problem for
American Indian/Alaska Native (AI/AN) women?

Type 2, or Non-Insulin Dependent Diabetes Mellitus, affects roughly 16 million Americans. For American Indians/Alaska Natives (AI/AN), both women and men, the incidence rate of type 2 (or adult) diabetes has reached epidemic proportions. Overall, 12.2 percent of AI/AN women and men over the age of 19 have been diagnosed with diabetes. For AI/AN women, the incidence rate is higher at 12.6 percent, compared with 10.2 percent for men. Specific tribes have much higher rates. For example, 50 percent of Pima Indians in Arizona who are between the ages of 30 and 64 have type 2 diabetes.

The following chart shows the incidence of diabetes by age among AI/AN women compared to non-Hispanic White women.

Sources: Data on American Indians/Alaska Natives from the 1997 Indian Health Service Patient Care Component file. Data on non-Hispanic Whites from the 1995 National Health Interview Survey.

Are many AI/AN women dying because of diabetes?

The death rate for the AI/AN population due to diabetes is about 2.7 times the rate for the general U.S. population. And researchers have suggested that this rate is actually even higher. At present, only deaths that list diabetes as the underlying cause are included in this mortality rate. This rate does not include the many deaths in which diabetes is a contributing cause. The death rate for AI/AN women has increased 550 percent over a 30-year period, reports a study conducted in New Mexico. This increase in women�s mortality rate from diabetes is more than twice that of AI/AN men.

Why are AI/AN women so susceptible to diabetes?

Diabetes has two main causes. One cause is genetics, which means that the disease tends to reoccur in the same population as people marry and have children within that population. Following that logic, full-blooded subpopulations (such as the Choctaw Indians) have the highest incidence rates of diabetes. The exact genetic causes of the disease are not yet known, but insulin resistance, which is common in Pima Indians, seems to play a part. Also, Pima Indian children are more likely to develop diabetes if their parents also developed diabetes at an early age.

The second cause of diabetes is lifestyle patterns. Obesity is a major risk factor for diabetes. Obesity has become a problem with the Pima Indians, and obesity rates in AI/AN populations (as in the general U.S. population) have been rising in recent decades. The lifestyle of the AI/AN population has changed. The common diet is now the Western diet, with high amounts of fat, and many individuals get little physical exercise. These lifestyle patterns contribute to obesity and are a direct risk factor for diabetes. In Pima Indians, who have a 50 percent incidence rate of diabetes, 95 percent of those with diabetes are overweight.

How does diabetes affect AI/AN women during pregnancy?

Pregnant AI/AN women with type 2 diabetes are at an increased risk of having babies born with birth defects. These women are also at risk of developing toxemia, a condition that endangers the lives of both the mother and the infant.

Diabetes that shows up in pregnancy is called gestational diabetes. This form of diabetes is more common among certain AI/AN tribes than in the general population. Gestational diabetes increases the baby�s risk for problems such as macrosomia (large body size) and neonatal hypoglycemia (low blood sugar).

Although the blood glucose levels of women with gestational diabetes usually return to normal after childbirth, these women have an increased risk of developing gestational diabetes in future pregnancies. In addition, studies show that many women with gestational diabetes will develop type 2 diabetes later in life. Follow-up studies of AI/AN women with gestational diabetes found them to have a high risk of developing subsequent diabetes: 27.5 percent of Pima Indian women developed diabetes within 4 to 8 years after pregnancy, and 30 percent of Zuni Indian women developed diabetes within 6 months to 9 years after pregnancy.

A child with a mother who had diabetes during pregnancy has a very high risk of becoming overweight or obese and developing diabetes at a young age. The exposure to the mother�s high blood sugar in the womb contributes to this risk. Longitudinal studies of diabetes in Pima Indians have shown that adult offspring of women with diabetes during pregnancy have significantly higher rates of diabetes than adult offspring of women without diabetes. In fact, 45 percent of the adult offspring of Pima Indian women who were diagnosed with type 2 diabetes prior to their pregnancy developed diabetes by age 20 to 24. In comparison, only 1.4 percent of adult offspring of women without diabetes during their pregnancy went on to develop diabetes by age 24.

The strongest single risk factor for diabetes in Pima children was exposure to diabetes in the womb.

What other complications of diabetes exist in AI/AN women?

Serious complications of diabetes are becoming more prevalent in American Indians and Alaska Natives. The most prominent or concerning are kidney (or renal) failure, amputations, blindness, and heart disease. Ten to twenty percent of all people with diabetes develop kidney disease, and the rate of diabetic end-stage renal failure is six times higher in AI/AN populations. The amputation rates are three to four times higher in AI/AN populations than in the general population. And diabetic retinopathy (which includes all abnormalities of the small blood vessels in the retina of the eye) occurs in 18 percent of Pima Indians and 24.4 percent of Oklahoma Indians.

Heart disease is the leading cause of death in the United States, and fatal coronary events are often linked to diabetes. However, these deaths would not be included in the mortality rates for diabetes because diabetes would be considered a "contributing" factor.

Infections, including tuberculosis, are of particular concern to both American Indians and Alaska Natives who have diabetes. A study of Sioux Indians showed that their rate of developing tuberculosis was 4.4 times higher if they had diabetes than if they did not.

How can AI/AN women manage diabetes?

Type 2 diabetes is usually treated by controlling diet, increasing physical activity, testing blood glucose levels at home, and, in some cases, taking oral medication or insulin or both. Approximately 40 percent of individuals with type 2 diabetes require insulin injections.

NWHIC; May 2001