Spotlight on American Indian and Alaska Natives Diabetes Care

Cathy Cabanban, RD, LDN, CDEOver the past month, I had the opportunity to deliver Conversation Map training sessions to educators in eastern Oklahoma and Flagstaff, Arizona. Not only did I meet a lot of great people, but I also learned more about the American Indian population. In my many years of practice outside of Chicago, I encountered only a handful of American Indian patients. It was wonderful to learn about their culture as well as barriers and successes in achieving good health from those of you who know and work with this population.

Did you know that there are 562 federally recognized American Indian and Alaskan Native tribes?

As far as Diabetes statistics go (from IHS website):

-16.3% of American Indian and Alaska Natives have diagnosed diabetes, compared with 8.7% of non-Hispanic whites

-The death rate due to diabetes for American Indians and Alaska Natives is three times higher than the general U.S. population (2004)

-An estimated 30% of American Indians and Alaska Natives have pre-diabetes

Healthy Interactions has trained approximately 220 educators in 100 different workplaces that provide health services to the American Indian and Alaska Natives populations. These facilities include hospitals, health clinics, health centers and health departments.

Image of Bread

Fry bread, a food born from adversity, remains a traditional staple with many American Indian people

The Indian Health Services division of Diabetes Treatment and Prevention lists the Conversation Map tools as the best practices tool for providing diabetes self-management education (http://www.ihs.gov/MedicalPrograms/Diabetes/index.cfm?module=toolsBPList).

Of course every population encounters barriers to good health, and I have learned of some of these challenges with the American Indian population. Many American Indians and their healthcare providers live in the same community and in close proximity to each other. When the healthcare provider runs out to the grocery store or pharmacy, she is likely to see her patient. This is in sharp contrast to those of us who work in large metropolitan areas. I saw thousands of patients over the years and only remember seeing a patient out in my community twice!

Many educators may assume that their patients may not want to talk during a Conversation Map session, fearing that if they open up about their health and personal habits, others in the community will find out. We know that in order for a Conversation Map session to be successful, participants must feel free to express themselves. Try to make it clear at the beginning of your session that what is said in a session stays there. You may also want to assure your patients that when you see them at the store or a party, you are not there as an educator, you are just a fellow shopper or partygoer. Let them know that their privacy will be respected. Taking a few moments to set some “ground rules” before your session can do a lot to ease your patients’ fears and apprehensions.

A big thank you to the educators I met in these cities. Even though I came to educate you, I learned a lot during the process!

Northern Arizona

Beautiful northern Arizona (above) and eastern Oklahoma (below). I was driving when I took these, so my photos do not do the surroundings justice!


Do you work with an ethnic or cultural group different from your own? Can you share some of the challenges and rewards of working with these populations?

Sorry there are no photos of Alaska, but I have not traveled there yet. If I do, I will be sure to post!



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