American Indian/Alaska Native Communities Prevent Type 2 Diabetes
American Indians and Alaska Natives (AI/AN) have a greater chance of having type 2 diabetes than any other US racial group. The Special Diabetes Program for Indians (SDPI) Diabetes Prevention demonstration projectexternal icon successfully reduced the risk for type 2 diabetes in participants within AI/AN communities.1-3 Indian Health Service (IHS), tribal, and urban programs with experience in type 2 diabetes prevention are well-positioned and encouraged to apply for CDC recognition to offer the CDC-led National Diabetes Prevention Program (National DPP) lifestyle change program for reimbursement and long-term sustainability. Organizations without prior lifestyle change program experience are also encouraged to apply.
The SDPI Diabetes Prevention Program Toolkitexternal icon is a helpful resource for tribal and urban health programs initiating or maintaining a CDC-recognized lifestyle change program. The toolkit includes stories, strategies, positive outcomes, and lessons learned by the 36 SDPI Diabetes Prevention demonstration project health care settings across 80 AI/AN tribes and the successes are reported in the Special Diabetes Program for Indians 2014 Report to Congress pdf icon[PDF – 472 KB]external icon.1
Congress established the SDPIexternal icon in 1997 to address the epidemic of type 2 diabetes among AI/AN people, with the vision of funding diabetes treatment and prevention services through the IHS and tribal and urban health programs across the United States. SDPI currently funds over 300 local, community-directed programs to address diabetes treatment and prevention, with a focus on healthy eating, physical activity, and linkages with health care teams.
In 2004, Congress provided additional funds to implement the SDPI Diabetes Prevention demonstration project, adapting the lifestyle intervention from the landmark National Institute of Health-led Diabetes Prevention Program (DPP) that shows that lifestyle intervention can reduce new cases of type 2 diabetes among individuals at high risk, including American Indians.
The SDPI Diabetes Prevention demonstration project’s 16-session curriculum, Native Lifestyle Balance, was delivered in group settings and supplemented by monthly individual lifestyle coaching sessions in 36 settings, across 80 tribes, and urban health care settings. After course completion, participants engaged in quarterly individual lifestyle sessions, as well as group and community diabetes prevention activities during the remainder of the year. At the conclusion of the SDPI Diabetes Prevention demonstration project, the programs disseminated strategies and lessons learned through resources such as the SDPI Diabetes Prevention Program Toolkitexternal icon. Many of the SDPI Diabetes Prevention demonstration project settings continued their prevention work and reported outcomes for participants who continued in the program for 3 years1,2 and up to 10 years.3
The CDC-led National DPP is a partnership of public and private organizations working together to help adults with prediabetes prevent or delay getting type 2 diabetes. The National DPP lifestyle change program offers the following:
- A structured year-long program (in-person group, online, distance learning, or combination).
- A trained lifestyle coach.
- A CDC-approved curriculum.
- Direct interaction between the lifestyle coaches and participants.
- Focuses on behavior modification, managing stress, and peer support.
CDC’s Diabetes Prevention Recognition Program (DPRP) is the quality assurance arm of the National DPP. Through the DPRP, CDC awards recognition to organizations that are able to meet national standards and achieve the outcomes proven to prevent or delay the onset of type 2 diabetes.
IHS, tribal, and urban health programs must use an approved curriculum that meets CDC requirements for recognition, such as the following:
- The PreventT2 curriculum.
- The CDC-approved Native Lifestyle Balance curriculumexternal icon.
- Other tailored curriculum reviewed by DPRP for consistency with the current evidence base and approved for use.
CDC recognition offers many benefits:
- Quality—linked to national quality standards and outcomes pdf icon[PDF – 702 KB] proven to prevent or delay onset of type 2 diabetes.
- Data—to monitor progress individually by program and collectively across the United States.
- Sustainability/Reimbursement—for program reimbursement, many private and public payers require CDC recognition, including Medicare.
- Support—CDC-recognized programs have access to technical assistance, training, and support.
- Marketing—CDC recognition can be an effective marketing tool to encourage participant referrals. To learn more about CDC recognition, review the Diabetes Prevention Recognition Program Standards and Operating Procedures.
To learn more about CDC recognition, review the Diabetes Prevention Recognition Program Standards and Operating Procedures. To determine if your organization is ready to apply for CDC recognition, complete a short capacity assessment pdf icon[PDF – 88 KB].
1 Indian Health Service. Special Diabetes Program for Indians—2014 report to Congress. Rockville, Maryland: Indian Health Service; 2014. https://www.nihb.org/sdpi/docs/05022016/SDPI_2014_Report_to_Congress.pdf pdf icon[PDF – 472 KB]external icon
2Jiang L, Manson SM, Beals J, Henderson WG, Huang H, Acton KJ, Roubideaux Y, and the Special Diabetes Program for Indians Diabetes Prevention Program. Translating the diabetes prevention program into American Indian and Alaska Native communities. Diabetes Care. 2013; 36(7):2027–2034. https://www.ncbi.nlm.nih.gov/pubmed/23275375external icon
3 Jiang L, Johnson A, Pratte K, Beals J, Bullock A, Manson SM and the Special Diabetes Program for Indians. Long-term outcomes of lifestyle intervention to prevent diabetes in American Indian and Alaska Native communities: the Special Diabetes Program for Indians Diabetes Prevention Program. Diabetes Care. 2018; 41(7):1462–1470. https://doi.org/10.2337/dc17-2685external icon