Effect of special diabetes program for Indians funding on system changes in diabetes care and outcomes among American Indian/Alaska Native people 1994–2004

Abstract

Objectives. The Alaska Native Medical Center diabetes program analysed Diabetes Care and Outcomes Audit data from 1994-2004 to evaluate the impact of the Special Diabetes Program for Indians (SDPI) funding on process and intermediate outcomes. Study Design. We conducted a retrospective analysis of data from standardized medical records reviews conducted between 1994 and 2004 from regional sites in Alaska. Methods. We analysed 7,735 randomly selected records for trends over three time periods (pre-SDPI, transition and SDPI). Results. Hemoglobin A1c, total and LDL cholesterol, triglycerides and blood pressure significantly improved from the pre-SDPI to the SDPI period. However, as the number of people with diabetes increased, the percentage of patients receiving foot, eye and dental exams decreased, as did the percentage receiving nutrition, exercise and diabetes education. Conclusions. SDPI funding provided resources for interventions necessary to improve the effectiveness of diabetes care. This was associated with improved intermediate outcomes in American Indian/Alaska Native patients with diabetes. Further observations are needed to evaluate whether or not intermediate outcomes result in decreased cardiovascular disease, amputations, dialysis and retinopathy. (Int J Circumpolar Health 2008; 67(2-3):203-212)

Management of type 2 diabetes mellitus in Greenland, 2008: examining the quality and organization of diabetes care

“…The monitoring found in the present study was of lesser quality than reported recently in the follow-up study after implementation of the Special Diabetes Program for Indians (12). Screening rates after implementation within 12 months were 85% (lipid profile), 67% (foot exam) and 56% (eye exam).…”

Diabetes prevalence, incidence, complications and mortality among Alaska Native people 1985–2006

“…It is possible that improving metabolic control is contributing to our lower rate over time compared to other populations. Data from the Diabetes Standards of Care and Outcomes audit showed that mean HDL has increased; mean systolic and diastolic blood pressures, hemoglobin A1c, total cholesterol, low-density lipoproteins and triglycerides have steadily declined from 1994 to 2004 among Alaska Native people with diabetes (6). The lower amputation rates seen in our population may be due to an increase in the number of people with a shorter duration of diabetes.…”

“…This decrease was true even when duration of diabetes was taken into account (35). It is possible that our renal replacement and death rate has decreased due to improved control of blood sugar and blood pressure as well as increased use of renal-protective medications, as has been observed among Pima Indians, other south-west U.S. Indians and the Indian Health Service as a whole (6,(35)(36)(37). Renal failure rates may appear lower if patients die of CVD prior to starting dialysis or if they die of diabetic renal failure (36).…”

“…We have also noted improved lipids, blood pressure and hemoglobin A1c in our population (6). Also, the use of a registry since 1985 has helped us to keep track of and provide optimal care to patients with diabetes and this may be associated with a decrease in death rates.…”

“…Electronic medical records have been in existence since 1979 (1). Progressive improvements in hemoglobin A1c, blood pressure and lipids were associated with public health initiatives in diabetes care and prevention (6). Amputation and renal replacement rates have been found to be lower than those in other populations, but rates vary widely among the major ethnic groups within Alaska (3,4,7).The purpose of this report is to examine trends in prevalence, incidence and mortality of diabetes, and incidence of amputations, renal replacement and mortality among Alaska Native people with diabetes.…”