Making the Grade
ADA honors a diabetes prevention program for Native Americans
Chris Arnone knew that her Native American ancestry put her at higher risk for diabetes when she first joined a diabetes prevention program four years ago. At the time, she was struggling with her weight, high cholesterol, and high blood pressure. Knee pain made walking and exercise a challenge. Today, she is off her medication, maintains a healthy weight, and walks as much as 25 miles per week.
Arnone, 70, of San Jose, Calif., credits the diabetes prevention program at the Indian Health Center (IHC) of Santa Clara Valley with her dramatic turnaround. The comprehensive 16-week program, which serves Native American adults who have pre-diabetes, recently won an American Diabetes Association Voices for Change award. "[IHC's program] isn't just a diet program or an exercise program—it's a lifestyle change program," says Arnone, who is of Cherokee ancestry. "[The educators] made me aware that if I just sit on the couch and watch TV at this age, I won't be around much longer. They inspired me to keep active."
Jan Chacon, coordinator of IHC's diabetes prevention program, says it provides quality medical care while helping participants make healthy living part of their daily routines. Chacon, whose tribal affiliations are Comanche and Mescalero Apache, stresses the significance of not just physical well-being but also health of the "mind, heart, and spirit." This approach reflects traditional Native American attitudes about health and wellness, she says.
Chacon adds that discussing Native American culture and traditions has been important to the program's success. With 120 different tribes represented in Santa Clara County, the region has one of the most diverse Native American communities in the nation. Cultural experiences are woven into the program's quarterly alumni luncheons. "Then we discuss what we need to do as native people to change our habits and attitudes," she says.
The cultural approach is part of what earned IHC a Voices for Change award in the "innovation" category. ADA's Awakening the Spirit Team, which focuses on diabetes prevention and control among Native Americans and Alaska Natives, initiated the awards program this year to recognize successful use of federal funds (right). "In diabetes prevention as well as in good diabetes control, behavior change is one of the most challenging components," says Gale Marshall, chair of the Awakening the Spirit Committee. "[We were] impressed that IHC formed a foundation for behavior change that was also culturally relevant." Other Voices for Change award winners included the Indian Urban Clinic of Oklahoma City and the Pine Ridge (S.D.) Diabetes Prevention Program.
The Special Diabetes Program for Indians, established by Congress in 1997, provides $150 million a year for Indian Health Service programs aimed at preventing and treating diabetes in Native Americans. SDPI funds diabetes services at 399 tribal and urban American Indian health programs, including the Indian Health Center in Santa Clara County. Congress reauthorized SDPI last year to provide funding through August 2011.
Arnone was among the first to enroll in IHC's diabetes prevention program when it began in 2005. "That first week, I was assigned a counselor that I could call anytime during the business week [for help]," Arnone says. "The one-on-one support was beyond value."
Participants receive individualized plans from the program team, which includes a nutritionist, certified diabetes educator, kinesiologist, fitness instructors, and a certified health education specialist. They attend one-hour sessions once a week for 16 weeks. A group called Walking Spirit meets weekly for an hour-long walk, and its members are given pedometers and encouraged to record their miles during the rest of the week. The group walked more than 25,000 miles last year.
Of the 40 participants who have completed the IHC program over the past four years, only two have since been diagnosed with type 2 diabetes, Chacon says. Arnone is not one of them. She shed 35 pounds during the program. Today, she monitors her diet and stays active, which she says is "time-consuming but worth it." One day a week she resolves to walk everywhere she goes, and every day she walks a mile to and from a coffee shop with her 85-year-old mother-in-law. "The program gave me a new lease on life," Arnone says. "It was honestly the best thing that's ever happened to me."