PLANNING GRANT--DIABETES/NEPHROPATHY IN APACHE INDIANS

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This application i in response to RFA 91-DK-01 and represents a proposal for support of the planning necessary to develop a grant application to study prevalence, complication rate and risk factors associated with diabetes mellitus in American Indians. The planning effort for which support is requested will be focused upon a study of the White Mountain Apache reservation. There is also available in this area a Hopi Tribe that could be used to provide comparable data and permit comparison of two different native American groups. The primary focus, however, will be directed toward the White Mountain Apache group since these individuals have been studied in the past and there is a uniquely relevant feature of this group related to their nutritional status which makes the assessment of diabetes mellitus in this Apache group of particular importance. In contrast to other groups such as the Pima who have been well-studied and who have a very high incidence of excess obesity as well as diabetes, two relatively recent assessments of the nutritional status of school children of this White Mountain Apache group failed to identify the prevalence of obesity that has been documented for the Pima and for other Navajo. Comparison of data from the White Mountain Apache Indians with data from other Native American populations should aid development of information that is of importance in deciding whether the excess obesity is the most important risk factor associated with non-insulin dependent diabetes mellitus. The grant planning process will include careful attention to appropriate population sampling as well as to the identification of the most accurate approach to characterization of the prevalence of diabetes mellitus as a function of age and nutritional status. Furthermore, any successful planning must involve close consultation and collaboration with the leaders of the White Mountain Apache community as well as the Indian Health Service to ensure optimal cooperation of the Apache community is obtained before any research project is initiated. In addition assessment of the complications including hypertension and renal involvement will be addressed.