Reducing Diabetes Disparities on the Wind River Indian Reservation

The purpose of this 5-year, $2 million project, awarded to Sundance Research Institute by the Merck Foundation’s Alliance to Reduce Disparities in Diabetes, was to create and support a comprehensive community–health system partnership to reduce the substantial health disparities experienced by American Indians as compared with the general population, and to improve outcomes for American Indian people with diabetes. The age-adjusted prevalence of diabetes among American Indians and Alaska Natives served by IHS is substantially higher than for other racial/ethnic groups in the United States, at 16.1 percent of the adult population. Although there has been considerable attention to development of strategies and interventions to reduce diabetes risk factors in this population, there has been limited research on the effectiveness of these interventions.

This project included design and implementation of an interventional program conducted by participating Tribes, in partnership with IHS clinicians, to improve diabetes management and outcomes for Tribal members diagnosed with diabetes or prediabetes. Interventions included the development of culturally-tailored diabetes self-management education (DSME) programs, training of Tribal staff to deliver DSME, which was then followed by 16 weeks of additional physical activity based on the Lifestyle Balance program and the creation of a community–clinical partnership to increase cultural competency and effective patient–provider communication, referrals to the Tribal program, and sharing of data and resources to support people with diabetes.

Evaluation of the impact of the program indicated that DSME provided by lay health educators, combined with increased communication and support from IHS physicians, resulted in statistically significant increases in confidence in ability to manage diabetes, positive changes in self-reported eating patterns and physical activity levels, and improvements in perceptions of the support from the diabetes care team. Clinical outcomes were assessed using pre–post intervention clinical data for 103 program participants who had provided HIPAA authorization for release of these data. Findings indicate that that HbA1c levels declined for 46 percent, with a decrease in average HbA1c of 1.12 points. Participants with initial HbA1c levels above 12.0 achieved an average reduction of 3.0 points.

Final reports on the project included:

• A comprehensive strategy for prevention and management of diabetes for American Indians: Guide for replication of the Wind River Reservation Alliance for Reducing Diabetes Disparities project
• Diabetes Self-Management Education Curriculum Instructor Manual