Selected risk factors for diabetes in Native Americans

Since the early 1940s, type II diabetes mellitus has become a widespread health problem among the Native American peoples of North America. This paper focuses on some etiologic risk factors directly related to diet. Some interrelationships of these factors with genetic predisposition are discussed. The geographic focus is on Native American populations residing in Arizona because of the extensive studies on the epidemiology and biochemistry of diabetes among the Pima and other Arizona tribes. Obesity and alcohol abuse both directly produce adverse biochemical/physiological effects on glucose metabolism. In addition, alcohol abuse is indirectly diabetogenic by producing organ damage. The Western dietary and lifestyle acculturation in affected Native American populations is thought to be connected to their increasing obesity and diabetes incidence and prevalence. Acceptability and efficacy of treatment may be increased by greater participation of Native American health professionals in planning and implementation of research and treatment programs, and administration and staffing of health care facilities both on the reservation and in urban settings. The use of traditional foods among tribal groups, and the adoption of mutidisciplinary, local approaches to health programs should be encouraged.