DIABETES PREVENTION IN NORTHERN PLAINS INDIAN CHILDREN

北部平原印第安人中的糖尿病在温尼贝戈和 内布拉斯加州东北部的奥马哈印第安人年龄调整后最高 患病率和发病率分别是美国的8.8倍和7.7倍。这个 这些部落的糖尿病并发症在原油中也很严重 终末期肾病和下肢截肢率5.2 分别是美国利率的两倍和1.8倍。超过32%的学龄儿童 这两个部落的儿童超重--是美国的1.3倍。 对内布拉斯加州两个部落学龄儿童(K-12)的调查显示 表现出34%的黑棘皮病(AN)与 超重。此外，这些儿童中有很大一部分人的胰岛素水平 比非印度人口中的更多。由于An与 高胰岛素血症和随后的糖尿病发展，儿童 这些人患糖尿病的风险很大。基准数据在 夏延河苏族，比较部落，位于南达科他州西部 表示AN的患病率为20%。 该提案将决定是否可以开发出有效的方法来 通过适当的营养教育和增加 活动导致AN皮肤损害的严重程度降低 温尼贝戈和奥马哈印第安人儿童，同时降低他们的风险 治疗糖尿病的药物。该项目有4个组成部分：1)改编 针对美国印第安人儿童的Shapedown体重管理计划 既以家庭为基础(对于患有老年痴呆症的人)，也以学校为基础；2)以学校为基础 涉及餐饮服务部门的计划和锻炼计划 所有儿童；3)以社区为基础的活动有限，可能包括 日营、跑步/健身工作坊和印度舞；4)小型 确定体重减轻对AN的特定代谢影响的子组， 在严格控制的条件下，胰岛素水平和其他参数。 关于程序设计的这四个组成部分的具体要素 实施将基于焦点小组和关键访谈期间 需求评估阶段。此外，所有组件都将强调部落 关于饮食和锻炼的特定传统和价值观，以便 干预在文化上是敏感的、适当的和可接受的。 评估将包括监测人体测量和 AN在研究和比较部落中的存在/严重程度 确定体重变化率、体重变化率和严重程度的差异 这是一个。研究部落的空腹血糖、胰岛素和血脂将 被监视。干预措施将在年内最后一年实施。 比较部落，夏延河苏人。

Diabetes among Northern Plains Indians is epidemic with Winnebago and Omaha Indians in Northeastern Nebraska having the highest age-adjusted prevalence and incidence, 8.8 and 7.7 times the respective U.S. rates. The complications of diabetes in these Tribes are also significant with crude rates for end-stage renal disease and lower extremity amputations 5.2 times and 1.8 times the U.S. rates respectively. Over 32% of school age children in these 2 Tribes are overweight - 1.3 times the U.S. rate. Surveys among school age children (K-12) in the 2 Nebraska Tribes have demonstrated a 34% rate of acanthosis nigricans (AN) associated with overweight. Also, a large proportion of these children had insulin levels greater than in the non-Indian population. Since AN is correlated with hyperinsulinemia and the subsequent development of diabetes, children with AN are at great risk for developing diabetes. Baseline data in the Cheyenne River Sioux, the comparison Tribe, in Western South Dakota indicates a prevalence rate for AN of 20%. The proposal will determine whether effective methods can be developed for weight control through appropriate nutrition education and increased activity resulting in a reduction in severity of the AN skin lesion among Winnebago and Omaha Indian children and simultaneously reduce their risk for developing diabetes. The project has 4 components: 1) adaptation of the SHAPEDOWN weight management program for American Indian children that is both family-based (for those with AN) and school-based; 2) school-based program involving the food service department and an exercise program for all children; 3) limited community-based activities which might include day camps, running/fitness workshops, and Indian dancing; and, 4) small sub-groups to determine specific metabolic effects of weight loss on AN, insulin levels, and other parameters under strictly controlled conditions. Specific elements of these 4 components regarding program design and implementation will be based on focus groups and key interviews during a needs assessment phase. In addition, all components will emphasize Tribal specific traditions and values regarding diet and exercise so that the intervention is culturally sensitive, appropriate and acceptable. Evaluation will consist of monitoring anthropometric measurements and the presence/severity of AN in both the study and comparison Tribes to determine differences in rates of weight change and in rates ,and severity of AN. Fasting blood glucose, insulin and lipids in the study Tribe will be monitored. The intervention will be implemented the final year in the comparison Tribe, the Cheyenne River Sioux.