Document Type

Capstone Experience

Graduation Date


Degree Name

Master of Public Health

First Committee Member

Liz Lyden


Diabetes is a major public health problem in American Indian Alaska Native (AI/AN) population which contributes to an increased number of morbidity and mortality.

Diabetes was largely unknown in AI/AN communities before the World War II but soon after the WWII Indian Health Service (IHS) providers began reporting diabetes among this population. (McLaughlin, 2010). A group of researchers in 1963 identified the first type II diabetes epidemic in Pima Indiana community of Arizona among AI/AN population. (Shultz, LO, et al, 2006). Soon, cases of diabetes in AI/AN more than doubled in prevalence rate compared to the general U.S. population, resulting in one in six AI/AN adults to be diagnosed with the disease. (McLaughlin, 2010).

Nationally, according to US Department of Health and Human Services, AI/AN are more than twice as likely to be diagnosed with diabetes as their non-Hispanic white counterparts (2.3 times higher). (DHHS, 2012). AI/AN in Nebraska are 4.4 times as likely to die from diabetes in comparison to non-Hispanic Whites (Nebraska DHHS Office of Health Disparities and Health Equity, 2015). Having an uncontrolled diabetes, defined as hemoglobin A1c>8.0%, for more than one year, despite the standard care they receive, is associated with a high risk and serious long-term complications such as cardiovascular disease, neuropathy, retinopathy, and nephropathy, (Crowley, et al, 2014). These complications are especially critical when diabetes is diagnosed at the end-stage renal failure (ESRF) which happens 2.7 times more in AI/AN than in non-Hispanic whites, (USDHHS). As recently as 2009, diabetes became the fourth leading cause of death among AI/AN populations. (McLaughlin, 2010). Therefore, diabetes in AI/AN results in a higher mortality rate for the population and it is growing much faster than it grows among the general U.S. population (62% vs 10%, respectively). (McLaughlin, 2010).

My project focuses on urban American Indian and Alaska Native (AI/AN) patients at Nebraska Urban Indian Medical Center (NUIMC), as NUIMC has identified uncontrolled diabetes as a priority health issue. Based on their 2018 report, from 106 adult male and female patients, 38% of patients had A1c level of greater than 9.0%. (NUIMC presentation/report 2018). Goal: The long-term goal of this project is to decrease the prevalence of uncontrolled diabetes in urban AI/AN patients seen at NUIMC by suggesting improvements and interventions as well as conducting literature review and evidence based researches. Specific aims: My study aims were a) to examine the prevalence of Urban American Indians’ uncontrolled diabetes at an urban AI/AN-serving clinic in Nebraska, the Nebraska Urban Indian Medical Center and b) to conduct a literature review to identify best practices for managing the disease. Methods: To assess the prevalence of diabetes, a manual chart review of the “IHS Diabetes Care and Outcomes Audit, 2019” was conducted. For the literature review, I used Google Scholar and PubMed.

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