Indian diabetes program up for reauthorization

Monday, April 9, 2007  

With Indian health care back on the agenda in Congress, tribal leaders are setting their sights on the reauthorization of an important diabetes initiative.

The Special Diabetes Program for Indians (SDPI) was created in 1997 to combat an epidemic of diabetes among Native Americans. According to government statistics, American Indians and Alaska Natives have the highest rate of the disease than any other racial or ethnic group.

But even as diabetes rates rise, particularly among young Natives, tribes and the Indian Health Service have seen successes through the program. Blood sugar levels -- one indicator of the disease -- have dropped in Indian Country, contributing to a 40 percent reduction in certain diabetes-related complications.

With additional funding, tribes hope to do even more. They are asking Congress to authorize $200 million a year over the next five years, up from $150 million a year currently provided through IHS grants.

"Eight years is not enough time to turn around the rates of diabetes," Buford Rolin, the chairman of the Poarch Band of Creek Indians of Alabama, said at a February 8 Senate hearing. "Give us time."

The effort to reauthorize SDPI is drawing some important bipartisan support on Capitol Hill. The leaders of the Congressional Diabetes Caucus and the Senate Diabetes Caucus are asking their colleagues to support Indian Country's call.

"Federally supported treatment and prevention programs are also showing real results in the American Indian and Alaska Native populations," Rep. Diana DeGette (D-Colorado) and Rep. Mike Castle (R-Delaware), the co-chairs of the House diabetes caucus, wrote in a March 2 letter.

The last time the program was authorized was in 2002, when it sailed through the House and Senate by unanimous consent. The move increased funding from $100 million a year to the current $150 million a year.

But the political landscape changed dramatically in the last two years. Tribes faced incredible opposition to major pieces of legislation, including the important Indian Health Care Improvement Act reauthorization, which was scuttled at the last minute by the Bush administration and some GOP senators.

This year, tribes and their supports in Congress hope the picture will be different. Sen. Byron Dorgan (D-North Dakota), the new chairman of the Senate Indian Affairs Committee, has made diabetes, and health care, one of his top priorities.

With the SDPI set to expire in September 2008, the National Indian Health Board -- on which Rolin serves as vice chairman -- is taking the lead on the effort. The goal is to reauthorize the program as soon as possible, before the 2008 presidential campaigns dominate the agenda.

NIHB counts nearly 200 supporters in the House and nearly 60 in the Senate. With just a few more in each chamber, the reauthorization could again sail through by unanimous consent.

Diabetes afflicts Native Americans at increasingly high rates. Among some tribes, as many as 50 percent of the adult population has the disease, which has no cure.

The majority of cases in Indian Country are of a form called Type 2. It results when the body can't use energy from food properly, resulting in fatigue, increased appetite, nausea, increased thirst and blurred vision.

If untreated, diabetes can lead to blindness, kidney failure and amputations.

Typically, type 2 diabetes was known only among adults. But it is showing up in Native children at earlier ages.

A CDC study showed that Native children ages 15 to 19 have the highest rate of type 2 diabetes in the country. The prevalence was nearly three times greater than non-Indian youth.

Diabetes is not just an Indian problem, however. Among the greater population, the CDC has reported a 30 percent increase during an eight-year period in the 1990s. This is tied to a growing number of overweight and obese Americans.

Treating type 2 relies on changing behaviors. Eating well and exercising more can prevent the onset of heart disease, stroke and high blood pressure.

Relevant Documents:
House Letter | Senate Letter

SCIA Hearing:
BUSINESS MEETING to consider pending legislative business, to be followed immediately by an OVERSIGHT HEARING on diabetes in Indian Country, with particular focus on the Special Diabetes Program for Indians (February 8, 2007)

Relevant Links:
National Indian Health Board - http://www.nihb.org
National Diabetes Program, Indian Health Service - http://www.ihs.gov/MedicalPrograms/Diabetes/index.asp