Diabetes and Associated Cardiovascular Complications in American Indians/Alaskan Natives: A Review of Risks and Prevention Strategies

Abstract

Diabetes mellitus (DM) is the seventh leading cause of death in the United States and the leading cause of death in the U.S. American Indian/Alaskan Natives (AI/ANs), who comprise only 2% of the total population. The AI/AN population has a high prevalence of DM in adults aged 20 years or older and is developing DM at a younger age than the general U.S. population. DM is a major risk factor for cardiovascular disease (CVD), and mortality from CVD is higher in AI/ANs than the general population, as is the prevalence of stroke and 1-year poststroke mortality for both genders when compared to non-Hispanic whites. A genome-wide scan found a number of chromosome linkages in the AI/AN population that suggest that genetic factors may contribute to their high risk of DM and CVD. Importantly, studies also suggest that in addition to race/ethnicity, cultural norms and historic conditions play important roles in the prevalence of DM and CVD in this population. Therefore, multiple factors should be taken into consideration when establishing prevention programs to decrease the prevalence of obesity, diabetes, and CVD incidence among adults and children in the AI/AN population. Prevention programs should focus on behavioral risk factors and lifestyle changes like encouraging smoking cessation, healthy diet, and increased physical activity while taking into consideration cultural, economic, and geographic factors.

Precision medicine in diabetes: a Consensus Report from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

“…A precision approach to diabetes care will require that the relevant laboratory methods and assays are carefully standardised and comparable. Assessments that need to be standardised include: For example, type 2 diabetes often manifests very differently in Native Americans than in people of European ancestry, with Native Americans tending to develop diabetes at a much younger age and experience loss of beta cell function earlier in the life course of the disease [132]. Recent insights following the ADA Precision Diabetes Medicine meeting in Madrid (held in October 2019) confirm that case-based interactive learning is an excellent way to support this type of postgraduate education for clinicians at all levels of training.…”

“…People with diabetes are the most important stakeholders. In Western countries, between 1:10 and 1:20 people have diabetes, while in other parts of the world, diabetes is more prevalent (1:3 in some middle-eastern populations [133], and 1:2 in some Native American tribes [132]). The precision approach to diabetes will require effective patient-facing, bidirectional communication strategies that explain what precision medicine is and how it works.…”

No Significant Difference in Outcomes for Surgical Treatment of Thyroid Cancer in Kidney Transplant Recipients - Analysis of the HCUP NIS Data

“…The incidence rates of post-operative complications following thyroidectomy were low for both KTxR and cardiovascular disease at a higher rate than the average non-Hispanic white population [23].…”

Practical Approaches to Treat ED in PDE5i Nonresponders

“…In addition, the side effects of some drugs used for comorbidities, such as selective serotonin-reuptake inhibitors, thiazides, and β-blockers, affect erectile function and thereby weaken the effect of PDE5is on ED [21][22]. Interestingly, unhealthy behaviors, such as excessive drinking, smoking, and a high-fat diet, can also promote the development and progression of these comorbidities in men, in turn affecting the efficacy of PDE5is in the treatment of ED [23][24][25]. Hence, lifestyle factors should be emphasized in ED treatment when there is the lack of a response to PDE5is.…”