The prevalence of type 2 diabetes increases with age. Patient medical records from Alaska health care systems show an increase of 215% in the presence of diabetes for all Alaska Native age groups from 1990 – 2003 (Figure 8). For those over 55, incidence of diabetes increased 185%, and in the age group that will become elders within the next ten years, those 45 – 54, incidence has increased 230%. This data predicts the continuing presence of diabetes in the Alaska Native older adult population, and with that a matched increase in disabilities related to diabetes. Regional and cultural differences in diabetes prevalence can also be found.
The Southeast Alaskan Indians (Tsimshians) have the highest prevalence, and the Eskimo populations of western and northern Alaska have the greatest increase in prevalence (Schraer, et. al. 1997).
Previous U.S. studies indicate that, “Diabetes complications, especially end-stage renal disease and lower extremity amputations, are major causes of morbidity and mortality among older Indians” (Jackson, 2000). Although there are still fewer cases of diabetes in Alaska, compared to American Indian populations in the Continental U.S., the prevalence continues to increase among Alaska Natives, and diabetes and its complications, including lower extremity amputations, can lead to an increased number of functionally impaired older adults.
With the increase in life expectancy for Alaska Natives, diabetes is predicted to also rise. Factors influencing the increased incidence are associated with lifestyle changes and the shift from traditional lifestyles with a predominantly subsistence diet and plenty of exercise, to a western lifestyle that includes more processed foods, unhealthy fats, simple sugars, and less physical activity. Studies among the Zuni Indians show that a diabetes program that includes both diet and exercise modifications can reduce the incidence of insulin usage in their older populations (Heath et. al. 1987; 1991).
Diabetes prevention activities such as those initiated under the Grants for Special Diabetes Programs for Indians will assist tribal organizations in combating the effects of this illness. All Alaska tribal health organizations participate in this program, which includes educational and activity programs and screening to identify people with diabetes at an early stage. These activities can help mitigate the functional decline in the elder population that has diabetes.