WASHINGTON – As the IHS enters the last year of congressionally authorized funding for its Special Diabetes Program for Indians, a number has emerged that proves the ongoing reduction of diabetes and its complications among Indians and Alaska Natives.
Dr. Charles Grim, former IHS director, now a policy consultant to the service, took care to explain the full significance of hemoglobin A1c, a blood test that provides a reliable indicator of glycemic (or blood sugar) control across a population.
Just to be clear about an epidemic condition, the Department of Health and Human Services (the parent department to IHS) explains diabetes as follows: In diabetics, the body does not produce and/or make healthy use of insulin, a hormone essential to the use of glucose (sugar) as cellular fuel. Persistent elevation of blood glucose levels leads to diabetes. In Type 2 diabetics, afflicting 95 percent of U.S. diabetics and a still higher percentage of American Indians, organ tissues show insulin resistance that in turn yields disease complications; these complications – which include kidney failure, lower limb amputation and cardiac, eye and nerve disease – are enormously expensive to treat. On top of the human cost, DHHS estimates, the financial cost of diabetes in the United States stood at $132 billion five years ago.
In part to parry the costs of diabetes, the IHS Indian Health Best Practices Workgroup has developed a systems-of-care approach to diabetes. Many of the Special Diabetes Program for Indians projects, supported by IHS funding, respond to the systems-of-care approach, which involves exercise, diet, education, lifestyle management and other preventive health measures to lower blood glucose levels among American Indians and Alaska Natives. The IHS Des Moines region, for instance, recently earned an award from the Iowa Health System for collecting and using data to improve care for diabetics served by the state;s IHS hospitals.
The proof that SDPI and other interventionary methods of the IHS are working, Grim explained, is that the hemoglobin A1c count has fallen by a full point population-wide among its clients. Though one point may not sound like much, Grim associated it with a 40 percent drop in complications from Type 2 diabetes.
A population-wide hemoglobin A1c count of seven or less is considered ”ideal glycemic control” within the medical profession. The count remains higher among American Indians and Alaska Natives, but since 1994 it has been on a steady downward trajectory, from well above nine to just under eight in 2005. A full 79 percent of the IHS service population with diabetes has obtained a hemoglobin A1c count, according to the IHS, setting the stage for further declines in the population-wide number.
