The Northern Plains Tribal Epidemiology Center has received a Native American Research Center for Health (NARCH) grant from the U.S. Department of Health and Human Services Indian Health Service. The Northern Plains Tribal Epidemiology Center will partner with UNMC.
The goal of the four-year grant, expected to total between $900,000 to $1.5 million, includes two research projects to build trust and facilitate research between American Indians and academic institutions. One of the projects will look at diabetes risk in American Indians youths and what can be done to prevent it. The other project is aimed at understanding asthma in American Indian youths.
“The grant presents an unparalleled opportunity to conduct health research — where partnership with tribal communities and building tribal capacity are at the foundation,” said Francine Romero, Ph.D., director of the Northern Plains Tribal Epidemiology Center and principal investigator of the Northern Plains NARCH grant. “Our collaboration with the University of Nebraska Medical Center will undoubtedly bring tangible benefits to tribes.”
The Northern Plains Tribal Epidemiology Center focuses on health research in tribes and is funded by the United States Indian Health Service. The center, established by the Aberdeen Area Tribal Chairman’s Health Board, serves 18 tribes in North Dakota, South Dakota, Nebraska and Iowa.
Jennifer Larsen, M.D., professor and section chief, UNMC diabetes, endocrinology and metabolism, said the project would focus on facilitating research and decreasing health disparities and distrust, as well as training researchers in American Indian communities.
“This is another step in trying to show universities can work with tribes to attack problems that they think are important, in ways that may be most effective and helpful to them,” said Dr. Larsen, principal investigator of the diabetes risk project. “The idea is to establish a long-term relationship to work on more than one problem.”
The prevalence of diabetes is increasing across the United States, but particularly in American Indian communities, where Type 2 diabetes is more than twice as common as in non-Hispanic white populations, Dr. Larsen said. “They also are at higher risk for diabetic complications, especially amputations and end stage renal disease, and are more likely to die from complications of diabetes,” she said.
Within the American Indian population, the greatest increases of Type 2 diabetes are among youths age 15 to 19. Programs have been initiated to try to reverse the trend, Dr. Larsen said, but they depend on identifying those at risk.
“We are now seeing new onset of diabetes in younger and younger ages,” she said. “A lot of the data we have about prevalence of diabetes and pre-diabetes is based on those who make it to the physician’s office. There may be a lot of kids who are at risk whom we’re not even seeing.
“This is a whole new thing to have diabetes starting so early. We’re seeing an epidemic of new onset of diabetes type 2 affecting the whole population.”
The prevalence of diabetes is increasing and varies from tribe to tribe, but is about 9 percent in adults for the Aberdeen Area Great Plains tribes, which is double that described for surrounding states. Prevalence of diabetes across Nebraska has increased in the Great Plains tribes by 16 percent from 1990 to 1997, Dr. Larsen said.
The diabetes project will evaluate the prevalence of insulin resistance in children of the Rosebud Sioux tribe. The goal is to identify the best predictors in children who might be at risk for diabetes, with the ultimate goal of preventing the onset of diabetes.
“There really haven’t been that many studies to date that really identify the prevalence of diabetes and pre-diabetes,” Dr. Larsen said. “With this study, we hope to gain a more accurate representation of why Native American youths are at higher risk than youths in other groups. Is it just related to disparities in the prevalence of obesity – there is some evidence this is true — but are there other disparities to explain why there is a higher risk for diabetes?”
Three hundred children, ages five to 18, will be screened on the Rosebud Sioux reservation in south central South Dakota. The Rosebud Clinic will serve as the primary study site.
Researchers will use traditional diabetes screening tools, which might identify kids at risk, such as body mass index and family history, as well as newer screening tools, including stress screening. If stress is found to be part of the risk of developing diabetes, Dr. Larsen said, it would change how physicians intervene to prevent and treat diabetes.
Researchers also will add a unique component to the grant: depression screening, which can be detrimental to diabetes, Dr. Larsen said.
“Depression and stress causes you to make extra hormones – adrenalin, for example,” she said. “Almost all the stress hormones inhibit insulin action. If you make the insulin, it doesn’t work as well so you have to make more – kind of like type 2 diabetes. When some people have stress, they decide to eat because it makes them feel better, so if you’re eating more, that also contributes to insulin resistance.”
The findings of the grant will be helpful to the tribes, Dr. Larsen said. “The hope is that the info we develop will be available to and valuable to the tribes and lead to more information that will improve on interventions we already have to more effectively prevent diabetes, not only in youths, but adults as well,” Dr. Larsen said.
In addition, the grant will look at whether involvement of youths in traditional and cultural activities of the tribe may serve as factors that protect against risk of insulin resistance.
The asthma project of the grant involves screening for asthma in Northern Plains tribal communities to identify the prevalence of risk of asthma in children that have not been diagnosed with asthma. Kim Rodehorst, Ph.D., assistant professor of the UNMC College of Nursing West Nebraska Division in Scottsbluff, will work with the Northern Plains tribal communities.
The project’s objective is to determine the number of asthmatic children currently undiagnosed, and identify those who aren’t receiving the appropriate level of care for their condition.
For more information about the study, contact Francine Romero, Ph.D., at (605) 721-1922 or epiromero@aatchb.org.