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Addressing Diabetes in Indigenous Communities
Addressing Diabetes in Indigenous Communities

The American Diabetes Association states that American Indians and Alaska Natives (AI/AN) have the highest prevalence of diabetes among all racial and ethnic groups in the US and are more than twice as likely to have diabetes than are non-Hispanic whites.

To lay the groundwork to reduce the prevalence of diabetes among AI/AN communities, a study conducted between 2006 and 2009 attempted to replicate the success of a previous clinical lifestyle intervention outside the walls of the clinic in indigenous communities. The resulting Special Diabetes Program for Indians Diabetes Prevention (DP) demonstration project developed, implemented, and evaluated culturally informed and community engaged lifestyle interventions that included 3,369 participants representing 80 tribes at 36 locations across the nation. While the study concluded that it was possible to successfully implement such programs at the community level, it also highlighted challenges in retaining participants.

According to Dr. Kelly Gonzales, a professor in the OHSU-PSU School of Public Health, challenges with participant retention notwithstanding, the dataset produced by the study contains important information on participant experiences of psychosocial stress, which includes discrimination, and other factors that could reveal insights into participant retention investigators had not been looking for when they originally conducted the study. Dr. Gonzales recently received funding from the NIH to conduct a secondary analysis of that data to see if she can identify those insights.

“The dataset from the Diabetes Prevention project is the largest of its kind, which makes it a great tool to work with,” Dr. Gonzales said. “And while the project produced really positive outcomes in terms of better diabetes management and prevention and demonstrated the benefits of creating opportunities for communities to tailor and manage interventions in ways that reflect and address their cultural needs, I think there is more that we can learn from it.” 

Dr. Gonzales’s hypothesis is that perceived discrimination is associated with lower levels of participant retention and that certain community-level factors act as a buffer to that discrimination, resulting in improved retention rates. She plans to test that hypothesis by reanalyzing the data with a specific focus on how discrimination impacts participation.

According to Dr. Gonzales, her reexamination of the Diabetes Prevention demonstration project data and other work she’s planning can help us better understand the ways negative factors like perceived discrimination and positive factors like community engagement influence retention in lifestyle interventions that promote health and well-being within AI/AN communities. With that knowledge, policy-makers and public health programmers working in collaboration with communities can develop inclusive, culturally informed approaches to addressing critical health disparities in underserved communities, which is essential to promoting health equity for all.