Uncontrolled Diabetes in Indigenous America: Causes and Solutions

This presentation explores the issue of uncontrolled diabetes among indigenous populations in America, highlighting its higher prevalence compared to non-indigenous groups and its association with increased mortality and morbidity. The presentation identifies key contributing factors such as lifestyle choices (smoking and alcohol consumption), unhealthy diets, increased obesity trends, genetic predispositions, and inadequate governmental support. It also points out gaps in existing research, particularly the lack of perspectives from indigenous communities themselves regarding diabetes management and lifestyle choices. To address these gaps, the presentation proposes a qualitative research approach using open-ended questionnaires to gather insights from indigenous Americans, aiming to understand their experiences and inform more effective, person-centered healthcare strategies. Ethical considerations, including informed consent and privacy, are also emphasized. The ultimate goal is to improve government strategies, enhance healthcare facilities, and raise disease awareness within indigenous communities.

Uncontrolled
diabetes in
indigenous
America
Presented by:

Introduction
 Diabetes: Increase in the blood sugar level in the body
There are three common types of diabetes
 Type 1 Diabetes Mellitus (T1DM) or insulin dependent diabetes
mellitus
 Type 2 Diabetes Mellitus (T2DM) or insulin independent
diabetes mellitus
 Gestational diabetes [1]
The following presentation will highlight the important points
highlighted in the narrative review of uncontrolled diabetes
among indigenous population of America

Diabetes in Indigenous
American population
 The occurrence rate of diabetes is comparatively higher among the
indigenous population in America than non-indigenous population
 Unmanaged diabetes increase the mortality and morbidity rate
among indigenous population especially Alaska Natives
 Gestational diabetes is higher among Eskimo women
 Type 2 diabetes is higher among the Aleut men
 Unmanaged diabetes is mostly popular among the indigenous
Mexican and Caribbean residing in the central and Southern part of
America [2]

Methods undertaken for literature
search
 Search of the literary articles through electronic
databases
 Databases used: Pubmed, CINHAL, Cochrane
and MedLine
Inclusion criteria Exclusion Criteria
Articles published after 2010 Articles published before 2010
Articles published centering
Indigenous Americans
Articles published other than English
Articles containing focus group:
Indigenous Americans
Articles containing focus group:
other than Indigenous Americans

Search Strategy
Keywords used
Disease type keyword Focus population
Diabetes Indigenous American
Population
OR OR
Type 2 Diabetes Native Americans
OR OR
Type 1 Diabetes Aboriginals Americans
OR
Diabetes Mellitus
Combination Boolean operator between disease type and
population: AND

Findings From the
Narrative Review

Diabetes in nonindigenous
population
Source: [3]

Life-style factors
 The main life style factors which increases the risk of
unmanaged diabetes among indigenous population are:
increased rate of smoking and alcohol consumption [2]
 Indigenous Americans like the Hispanic/Latino, Cuban,
Dominician, Mexican, Puerto Rican, Central American and South
American are more likely to smoke cigarettes [2]
 Native Americans tend to drink alcohol more than non-native
Americans [4]
 Increase in stress is a reason behind high alcohol consumption
and smoking of tobacco which make diabetes unmanageable [2]

Unhealthy Diet
 Indigenous Americans thrive on poor diet
 They mainly consume high fat and simple carbohydrate
rather than high fibre food or complex carbohydrate
 Poor work status is the reason behind poor diet
adherence which make diabetes uncontrollable [5]
 Lack of proper employment provides lack of proper
access of healthy diet like vegetables and fruits which
make diabetes unmanageable [5]

Increased Trends in
Obesity
 Indigenous Americans from Spanish origin are obese
genetically which increases the tendency of
developing diabetes at an uncontrollable rate [6]
 Latin Americans have high blood cholesterol level
which further increases the severity of diabetes [6]
 North American Natives suffer from childhood obesity
which increases susceptibility of T2DM which has no
cure [7]

Genetic factors
 Thirty genotype hypothesis is the most applicable genetic
factor under incontrollable diabetes among indigenous
Americans [8]
 This particular genotype make body resistant towards insulin
leading to development of T2DM which has no cure [8]
 Alaska Natives also has high genetic susceptibility of
developing diabetes.
 With increase in age, the severity of diabetes becomes
unmanageable in comparison to non-Hispanic white 2]

Lack of proper support
from government
 Lack of proper healthcare set up in the
rural regions of both southern and
northern part of America [8]
 Lack of proper medical insurance by the
government for management of diabetes
for the indigenous population [8]
 Lack of proper disease awareness [8]

Summary of the narrative
review
The main reasons underlying uncontrolled
diabetes among indigenous Americans:
 Lack of proper governmental support
 Lack of proper diet
 Genetic predisposition
 Increase trends in obesity
 High consumption of alcohol and
smoking

Gaps in the review
 The perspective underlying lack of
proper management of diabetes from
the perspective of indigenous American
population has not been recorded
 The reason behind the lack of
observance of healthy life style from the
perspective of indigenous Americans is
not recorded

Research aim
 To analyse the reasons underlying the
uncontrolled diabetes among the
indigenous Americans from their
perspectives

Research question
 What is health education status of indigenous people about
diabetes control in America?
 Whether the lack of proper health-care setup among
indigenous communities is the reason underlying uncontrolled
diabetes?
 Whether the lack of proper job opportunities are the reason
behind high alcohol consumption, smoking and obesity
leading to unmanageable diabetes?
 Do the indigenous population receive proper government
support in terms of health insurance to treat diabetes?

Proposed Methodology
 Qualitative Research approach with the help of
open ended questionnaire
 Research philosophy: interpretivism research
philosophy will help to analyse limited data source
 Research approach: Inductive research approach:
it will help to compare the outcome of the study
based on the perspective of the indigenous
community of America [9]

Proposed Methodology
(continued)
 Research design: Descriptive type: it will help
the researcher to establish relation between
the themes
 Sample Size: not less than 30 as it will help to
reduce biased response
 Sample characteristic: Adult indigenous
American population suffering from diabetes
[9]

Ethical consideration of the
research
 Informed consent will be signed before the onset of the
interview
 In the informed consent, the purpose of the interview and the
research questions will be highlighted and explained in details
 None of the interview questions will have personal questions
that might hurt the sentiment of the respondents
 None of the personal information like name and address will
be revealed in the research under the ethical principal of
privacy and confidentiality [10]

Ethical Consideration
(continued)
 The participants will not be forced under any
circumstances to participate in the interview
 Participants will be allowed to leave the
interview at any point of time as per the
ethical principle of autonomy [10]
 The time and place of the interview will be
selected as per the convenience of the
respondents

Projective time frame
Task Wee
k 1
Wee
k 2
Wee
k 3
Wee
k 4
Wee
k 5
Wee
k 6
Detailed analysis of
literature review
Framing interview
questionnaire on basis
of literature review
Selection of the focus
group
Conduction of the
interview with open
ended-questions
Analysis of the
interview
Narrating the final
results

Rationale of conducting
the research
 Person-centered approach in the
management of diabetes among the
indigenous Americans
 Improvement of the government strategies
and facilities in health promotion among
indigenous Americans
 Increase in the disease awareness among
indigenous Americans

References
 Centre of Disease Development. Native Americans with diabetes. (2018). Access date: 19th September 2018.
Retrieved from:
https://www.cdc.gov/media/dpk/diseases-and-conditions/native-americans-diabetes/native-americans-diabetes.html .
 U.S Department of Health and Human Services Office of Minority. Diabetes and American Indians/Alaska Natives.
2016. Access date: 21st September. Retrieved from: https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=33
 Spanakis EK, Golden SH. Race/ethnic difference in diabetes and diabetic complications. Current diabetes reports.
2013 Dec 1;13(6):814-23.
 Cunningham JK, Solomon TA, Muramoto ML. Alcohol use among Native Americans compared to whites: Examining
the veracity of the ‘Native American elevated alcohol consumption’belief. Drug and alcohol dependence. 2016 Mar
1;160:65-75
 Ajala O, English P, Pinkney J. Systematic review and meta-analysis of different dietary approaches to the
management of type 2 diabetes–. The American journal of clinical nutrition. 2013 Jan 30;97(3):505-16
 Ingaramo RA. Obesity, diabetes, and other cardiovascular risk factors in native populations of South America.
Current hypertension reports. 2016 Jan 1;18(1):9.
 Schell LM, Gallo MV. Overweight and obesity among North American Indian infants, children, and youth. American
Journal of Human Biology. 2012 May;24(3):302-13.
 Hales CN, Barker DJ. Type 2 (non-insulin-dependent) diabetes mellitus: the thrifty phenotype hypothesis.
International journal of epidemiology. 2012 Oct 23;42(5):1215-22.
 Parahoo K. Nursing research: principles, process and issues. Macmillan International Higher Education; 2014 May 30.
 Saunders B, Kitzinger J, Kitzinger C. Anonymising interview data: Challenges and compromise in practice. Qualitative
Research. 2015 Oct;15(5):616-32.