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Diabetes-related ESRD declines among Native Americans
The rate of diabetes-related end-stage renal disease among Native American adults has fallen by more than half in the past 2 decades, a trend attributed to sustained improvements in both process and outcomes measures, according to a new Vital Signs report from the CDC.
The rate of diabetes-related kidney failure among Native Americans has declined at the fastest rate for a U.S. racial group, according to the report, which cited population-based approaches to diabetes management and improvements in clinical care by the Indian Health Service as central to the findings. About two of three Native Americans with kidney failure have diabetes.
The effort is “a superb example of how public health can save both lives and money,” Tom Frieden, MD, MPH, director of the CDC, said during a press briefing.
“The implications of these findings are not just important for Native Americans and Alaskan natives,” Frieden said. “They’re important for all Americans. The bottom line is this: Although diabetes is our leading cause of kidney failure ... it can be prevented. Untreated or poorly controlled diabetes may result in kidney disease that progresses to kidney failure that requires either dialysis or kidney transplant. The approaches implemented by the Indian Health Service are applicable and scalable for all people with diabetes.”
Ann Bullock, MD, of the division of diabetes treatment and prevention, Indian Health Service, and colleagues analyzed data from the U.S. Renal Data System, the Indian Health Service, the National Health Interview Survey and the U.S. Census to calculate ESRD incidence rates by race among U.S. adults between 1996 and 2013, and in the diabetic population between the same period. Rates were age-adjusted based on the 2000 U.S. standard population. Researchers analyzed measures of care for Native Americans with diabetes using the Indian Health Service Diabetes Care and Outcomes Audit.
Researchers found that, among Native American adults, age-adjusted rates of diabetes-related ESRD per 100,000 population fell 54%, from 57.3% in 1996 to 26.5% in 2013, a rate similar to white adults with diabetes.
“This decline is especially remarkable given the well-documented health and socioeconomic disparities in the [Native American] population, including poverty, limited health care resources and the disproportionate burden of many health problems,” the researchers wrote.
The decrease in diabetes-related ESRD was “likely the result of improvements in both process and outcomes measures,” the researchers noted. Frieden mentioned several improvements:
In 2015, average blood pressure among Native Americans with diabetes and hypertension was 133/76 mm Hg.
The average HbA1c among Native Americans with diabetes decreased 10%, from 9% to 8.1% between 1996 and 2014.
In 2016, 62% of Native Americans with diabetes aged at least 65 years underwent urine albumin-to-creatinine ratio testing compared with 40% in the general U.S. population in 2013.
In 2014, 76% of Native American adults with diabetes were prescribed angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists in 2014 compared with 56% in the general U.S. population between 2009 and 2014.
“The approaches aren’t unique for diabetes management, but they were applied earlier and more comprehensively,” Frieden said.
Frieden noted several “components for success” that contributed to the decline, including team-based approaches for patient education, access to dietitians and community health workers, programs addressing patient health care barriers and better outcomes measures.
In 1997, Congress established the Special Diabetes Program for Indians, which provided funding to Native American sites to implement interventions that reduce risk factors for diabetes, according to study background. The Indian Health Service has also used the funding to improve its national program for disseminating evidence-based recommendations and provide training, tools for data collection and support to diabetes programs. – by Regina Schaffer
For more information:
The CDC report is available at: https://www.cdc.gov/vitalsigns/.
Disclosure: Frieden is director of the CDC. Bullock reports no relevant financial disclosures.