Diabetes team focuses on Natives

Incidence of the disease jumped 104 percent from 1990 to 2004

By Ann Potempa
Anchorage Daily News

Judith Thompson, a pharmacist at Alaska Native Medical Center, is part of a diabetes team to help Alaska Natives deal with the disease. Thompson is a lieutenant commander for the U.S. Public Health Service.

A special team at the Alaska Native Medical Center is focusing its efforts on the growing number of Alaska Natives living with diabetes.

The Alaska Area Diabetes Team has a unique approach for treating Anchorage and rural residents with the disease, caused by high levels of blood sugar.

Patients with diabetes who come to the clinic are met by several, not just one, health care providers. A doctor or a nurse practitioner visits the patient, then a registered dietitian and a pharmacist. In other words, the patient has to make only one stop to get medical care, nutritional advice and medication.

"The pharmacy comes to them," said Judy Thompson, a pharmacist and lieutenant commander with the U.S. Public Health Service Commissioned Corps. "They don't have to go to the pharmacy."

The team has a similar approach for patients in rural Alaska. Instead of making the patients fly all the way to Anchorage, the diabetes team flies to rural communities to see them, said Carol Treat, a registered dietitian and another lieutenant commander with the Commissioned Corps.

The team wants to stop new cases of the disease and a related list of complications -- including cardiovascular disease, vision loss, kidney failure, amputations, even early death.

"If you can prevent the disease, you can stop the complications," said Dr. Terry Raymer, also on the diabetes team.

The picture of diabetes among Alaska Natives has changed dramatically in the past half century. Research that ended in the 1950s revealed only one case of diabetes among 705 Eskimos studied. Today, a statewide registry lists about 3,300 Alaska Natives -- not just Eskimos -- with the disease, said Raymer. That means 38 of every 1,000 Alaska Natives has diabetes, after adjusting for age.

What's most telling, however, is the rate of increase, Raymer said. Between 1990 and 2004, there was a 104 percent increase in diabetes prevalence among Alaska Natives here. Nationwide, the increase in prevalence was 76 percent.

"That's terrible," Raymer said. "To me, that's very concerning."

The reasons for the rise are complicated, Raymer said. Treat said the increase is partly due to a change in lifestyle among Natives.

"They had to go chop wood, had to go haul water, had to hunt," Treat said. "Now we don't have to do those things." Televisions and four-wheel vehicles have made life even more sedentary. For some Natives, subsistence foods have been replaced by processed meals that have fewer nutrients but more calories, she said. All of this can lead to weight gain around the middle, which is related to developing diabetes, she said.

This type of diabetes used to be called adult-onset diabetes, but Alaska Natives are now getting the disease at younger ages. The youngest patient this year was 14 years old, Treat said. Diabetes doesn't go away, so a diagnosis at a young age means there are more years during which complications can develop.

To stem the problem, Raymer joined the Alaska Area Diabetes Team this summer to treat patients with the disease. Treat teaches the patients about diabetes, nutrition and regulating their blood sugars. Thompson said she makes sure patients are on the right medications. She asks them if they're having problems taking the drugs. When new patients come in, the team also teaches them how to inject insulin, another way to manage the disease.