State of New Mexico Diabetes Prevention and Control

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State of New MexicoDiabetes Prevention and
ControlDiabetes and Obesity

• Presentation by
• Robert Nakai, Program Supervisor III

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Project Mission

• To Promote and Reduce the incidence of Diabetes
  Mellitus Type 2 on the Navajo Nation
• Primary Prevention prevent new cases of diabetes
  by reducing the prevalence of obesity, nutrition
  education and by increasing physical activities
• Secondary Prevention identify persons who have
  undiagnosed diabetes (i.e. screening) or at-risk
  individuals of developing diabetes who could
  benefit from intervention efforts
• Tertiary Prevention prevent the incidence and
  progression of serious complications of diabetes
  (reduction of the incidence and progression of
  diabetes-related complicationlower-extremity
  amputations, retinopathy and blindness and kidney
  failure (nephropathy)

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Project Components

• Diabetes Community Worker Program
• Traditional Education Project
• Standardization of Diabetes Terminology Training
• Modular Fitness Centers
• Window Rock Wellness Center
• Mass Media/Materials Development
• Dental Initiatives
• Youth and Community-Based Initiatives
• Data and Evaluation
• Navajo Nation Sub-Contracts
• Crownpoint, ,Dilkon, Many Farm and Tuba City
  Family Wellness Centers, Montezuma Creek,
  Monument Valley, Native Americans for Community
  Actions, Sage Memorial, and Cuba/Farmington
  Presbyterian Medical Services

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Project Objectives Primary Prevention

• Enhance and empower clients knowledge of
  diabetes prevention and wellness
• Monitor and provide technical assistance to
  subcontractors
• Implement innovative, educational media campaigns
• Plan and implement strategies to increase
  environmental support for physical activities and
  pursue excellence in staff development
• Advocate for healthy foods availability
  throughout the Navajo Nation
• Conduct health screening, early detection and
  health education to at-risk population
• Support and promote employee wellness, health
  education for Navajo employees through policy
  changes

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Program Objectives Secondary Prevention

• Promote healthy lifestyle through making healthy
  food choices, manage self care and participate in
  fitness education and help maintain diabetes
  registries
• Provide and coordinate comprehensive health
  education for childbearing age women with
  diabetes in pregnancy, collaborate in providing
  preconception outreach and counseling services
  and help maintain diabetes registries
• Conduct outcome evaluation to reduce the
  incidence rates of new diabetes cases and
  incidence/morbidity rates of diabetes related
  complications
• Conduct annual process evaluation on Navajo
  Special Diabetes Components

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Diabetes Budget Allocations
Balanced Budget Act of 1997 30 M each year for
5 years (1998-2002).Consolidated Appropriations
Act 100 M each year for 5 years
(2003-2008)Purpose Prevention and Treatment
Services for AI/ANs provided by IHS, Tribal
Health Programs pursuant to P.L. 93-638, and
Title V Urban Indian Health Programs.

• Navajo Nation
• FY 2001 - 1.4M
• FY 2001 Supplement -5.8M
• FY 2002 5.4M
• FY 2003 6.4M
• FY 2004 6.8M
• FY 2005 6.8M

• Navajo Area IHS
• FY 2001 2.7M
• FY 2001 Supplement -2.7M
• FY 2002 7.3M
• FY 2003 5.6M
• FY 2004 5.9M
• FY 2005 5.9M

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Diabetes and ObesityProject Highlights for 2005

• Worked with various communities and schools in
  implementing physical activities and exercise
  programs.
• Population served School aged children, Adult
  at risk (obese),
• Newly diagnosis DM patients, Pregnant Women
  Elderlies.
• Funding 3 Wellness Centers (Tuba City, Many Farms
  Crownpoint)
• Produce Radio Billboard Mass Media Campaigns
  focusing on Exercise and Nutrition
• Coordinate and facilitate SPARK Curriculum
  training and equipments to 883 Head Start
  Personnel (102 Head Start Centers)
• Coordinate and facilitate Trainer-the-Trainer
  Honoring the Gift of Heart Health Curriculum
  training to NSDP Personnel
• Implementing Golf Challenge at individualize to
  team activities.
• Coordinate and facilitated Youth and Adult Coed
  Basketball Program
• Coordinated and facilitated Adult Coed Volleyball
  program

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Diabetes and ObesityProject Highlights for 2005

• Worked with various communities and schools in
  implementing physical activities and exercise
  programs.
• Coordinated and facilitated Walking and Fitness
  Run Series Program (Just Move Its Series, Sweat
  You bet Fitness Series, Just for the Health of It
  Services)
• Conducted 3 Youth Camps with collaboration with
  other Youth Programs to introduce recreation and
  nutrition education.
• Sponsor 2nd Annual Mobilizing to Prevent Diabetes
  from Four Direction (Bicyclists, Horseback Riding
  Walkers. Runners)
• Coordinate and facilitated Youth Baseball Clinics
  with Arizona Fall Major Baseball Leagues Youth
• Conducted 7 Native Foods Expo to emphasis healthy
  native food preparation
• Coordinated and facilitated Kitchen Creation to
  address low fat, low sat, low sugar and high
  fiber diets.

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Leading Causes of Death 1964-1998
1964 1973 1983 1993 1998
ACCIDENTS ACCIDENTS ACCIDENTS ACCIDENTS UNINTEN- TIONAL INJURIES
INFLUENZA/ PNEUMONIA HEART DISEASE HEART DISEASE HEART DISEASE HEART DISEASE
GASTRITIS/ ENTERITIS INFLUENZA/ PNEUMONIA CANCER CANCER CANCER
CANCER CANCER INFLUENZA/ PNEUMONIA INFLUENZA/ PNEUMONIA PNEUMONIA/ INFLUENZA
HEART DISEASE CIRRHOSIS DIABETES DIABETES DIABETES
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Leading Reasons for Outpatient Visits
FY 2000 FY 2001 FY 2002 FY 2003
SUPPLEMENTARY CLASSIFICATION (PREVENTION, TESTS) SUPPLEMENTARY CLASSIFICATION (PREVENTION, TESTS) SUPPLEMENTARY CLASSIFICATION (PREVENTION, TESTS) SUPPLEMENTARY CLASSIFICATION (PREVENTION, TESTS)
RESPIRATORY (URI) RESPIRATORY (URI) RESPIRATORY (URI) RESPIRATORY (URI)
ENDOCRINE, NUTRITIONAL, METABOLIC DISEASES (DIABETES) ENDOCRINE, NUTRITIONAL, METABOLIC DISEASES (DIABETES) ENDOCRINE, NUTRITIONAL, METABOLIC DISEASES (DIABETES) ENDOCRINE, NUTRITIONAL, METABOLIC DISEASES (DIABETES)
ACCIDENTS COMPLICATIONS OF PREGNANCY AND CHILDBIRTH COMPLICATIONS OF PREGNANCY AND CHILDBIRTH COMPLICATIONS OF PREGNANCY AND CHILDBIRTH
SYMPTOMS, SIGNS, ILL-DEFINED CONDITIONS ACCIDENTS ACCIDENTS MUSCULO-SKELETAL, CONNECTIVE TISSUE
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Age-Adjusted Death Rates 1996-1998 per 100,000
Population
NAVAJO ARIZONA (1998) NEW MEXICO U.S. (1997)
UNINTENTIONAL INJURIES Motor Vehicle 135.1 84.1 41.8 21.0 53.6 46.3 30.1 15.9
HEART DISEASE 103.2 125.8 214.5 130.5
CANCER 87.5 114.2 175.8 125.6
DIABETES 41.1 13.5 27.3 13.5
PNEUMONIA/INFLUENZA 30.8 17.7 31.5 12.9
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Percent of Total Deaths 1996-1998
22
38
16
12
6
6
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Death Rates 1976-1997

• BETWEEN 1976 AND 1997 NAVAJO AREA AGE-ADJUSTED
  DEATH RATES FOR DIABETES HAVE INCREASED FROM 10.1
  TO 35.9 DEATHS PER 100,000 POPULATION, AN
  INCREASE OF OVER 255.
• IN 1976, THE U.S.-ALL RACES MORTALITY RATE FOR
  DIABETES WAS 11.1 AND IN 1997 HAD RISEN TO 13.5.
  THIS IS AN INCREASE OF 21.6.

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45
40
NAVAJO AREA
35
30
25
20
15
U.S.
10
5
0
1976
1980
1981
1982
1983
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
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Future Plans

• Collaboration with other Diabetes Health
  Resources
• Constructing State of Art Wellness Center
• Constructing Two Walking Trails (Introduce Winter
  Recreation/Fitness activities on one of trail
  site)
• Continue coordinating Preventive Education with
  NN Head Start Programs
• Provision of fresh fruits/vegetables, frozen
  foods thru NN Food Distribution Programs
• Implement Water Sport Programs and activities
• Develop and Construct three Skateboard Parks
• Purchasing Mobile Units to provide outreach
  services in remote communities (Health Screening,
  Diabetes Preventive Education and Fitness
  Activities)

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Thank You