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The Propensity of Non-Insulin Dependent Diabetes among Native Americans

Updated on December 27, 2016
J Schatzel profile image

J. Schatzel works in agricultural/occupational medicine in rural upstate NY and has a Masters degree in history.

An Overview

Non-insulin dependent Diabetes Mellitus (NIDM) has become a growing epidemic among Native American populations in the years following World War II. By the 1980s NIDM was twice as common among Native Americans as among other ethnic groups[1]. Many sociologists and anthropologists believe that lifestyle changes including increased sedentism and dietary changes that followed the Indian Boarding School movement and the Reservation movement of the early twentieth and late nineteenth centuries have led increasing numbers of Native Americans into circumstances of increased propensity to develop NIDM. Genetic researchers and evolutionary biologists also believe that Native Americans are genetically prone to develop NIDM, thus increasing the behaviorally induced risk of developing NIDM among Native American populations. Prevention of NIDM has thus become a major focus of many Native American communities and North American government agencies.

Ethno-historian Tony McMichael stated that “we can only understand human health and disease by looking at our species in the context of the wider ecosystems in which we participate”[2]. Non-insulin dependent Diabetes Mellitus is a disease caused by such environmentally induced behavioral factors as lifestyle changes including dietary changes resulting in increased obesity rates, decreases in physical activity, psychosocial stress, increased caloric intake, and increased sedentism. Consequently, research has shown that a return to consumption of traditional foods and an increase in physical activity can lead to the normalization of plasma glucose and insulin levels and reduce the risk of NIDM in Native American populations[3]. Physical activity has decreased in the conversion from traditional indigenous lifestyles to modern western lifestyles as occupations shifted from physically active outdoor jobs such as logging, farming, and fishing to more sedentary factory and office work. The decrease in physical activity among Native American populations accompanying the occupational shift of the “Reservation movement”[4] has resulted in an associated increase in obesity among such populations; thus providing a prominent risk factor for NIDM[5]. Increased fat and carbohydrate consumption coupled with increased individual caloric intakes has led to an increase in obesity among the general Native American populace thus increasing the rate of NIDM among such populations[6]. In 2002, over one hundred thousand Native American adults constituting nearly fifteen percent of those receiving care from the Indian Health Service were recorded to have NIDH; with a prevalence of NIDM at least three times that of non-Hispanic whites of similar age[7].

Another risk factor for NIDM besides obesity is physical and psychological stress on an individual. In the years following the Native American Boarding School movement of the early twentieth century, Native American populations were removed from their traditional lifestyles and in many instances forced to assimilate into racially defined constructs of Euro-American culture, thus resulting in high levels of psychological stress. High stress levels have been shown to raise cortisol levels, which resultantly increase the production of abdominal obesity and hyperinsulinemia[8]. Accompanying dietary and weight-distribution changes in Native American populations following the spread of retail outlets and growing number of restaurants accompanying the “Reservation Movement” of the late nineteenth and early twentieth centuries, increased stress levels from such drastic lifestyle changes have provided yet another risk factor for NIDM[9]. Likewise, stress increases the body’s levels of catecholamines, which “inhibit insulin production and impair the peripheral uptake of glucose”[10] leading to the development of further risk factors for NIDM. Latitude is a significant predictor of NIDM in Canada, where the highest prevalence of NIDM among Native Americans is in the southern regions in which the majority of the Euro-Canadian population resides[11]. In Native American communities of northern Canada, increased sedentism and high-sugar diets of southern Canadian regions with higher Euro-Canadian populations reside do not play as large of a role in traditional life and thus have less of an impact on inflicting NIDM in local populations

According to historian Alfred W. Crosby, “the molecules, blood, and tissues of Native Americans are a library that geneticists are beginning to be able to read, and we historians can learn a lot by looking over their shoulders” [12]. Likewise, researchers such as medical anthropologist Chakraborty have demonstrated that the rate of NIDM directly increases in conjunction with the proportion of Amerindian ancestry[13]. In most regions, the prevalence rates of NIDM among indigenous inhabitants are higher than among other citizens with similar dietary and behavioral environments[14]. Many genetic researchers believe they have located a series of genes commonly labeled “susceptibility genes”[15] that increases a person’s risk of developing NIDM. Such genes are found with higher frequency among Native Americans than among other ethnicities, and have been shown to highly influence a person’s cells to “secrete less and respond less to insulin that is needed to regulate blood sugar”[16]. Due to the fact that nutrition provides the “input variable”[17] in carbohydrate metabolism, and because human culture governs access to food, environmental involvement in NIDM has long been recognized and studied. Thus, the current epidemic of NIDM among Native Americans is evoked in large part by lifestyle changes in the years following World War II that have favored the emergence of NIDM in genetically susceptible individuals[18].


[1] Szathmary Emöke J. E. and R. E. Ferrell “Glucose Level, Acculturation, and Glycosylated Hemoglobin: An Example of Biocultural Interaction” Medical Anthropology Quarterly, New Series, Vol. 4, No. 3, Steps toward an Integrative Medical Anthropology (Sep., 1990), pp. 315-341, Blackwell Publishing on behalf of the American Anthropological Association p.315

[2] Ubelaker Douglas H. “The Origins of Native Americans: Evidence from Anthropological Genetics by Michael H. Crawford” The Journal of the Royal Anthropological Institute, Vol. 8, No. 2 (Jun., 2002), pp. 387 -388 Royal Anthropological Institute of Great Britain and Ireland

[3] Szathmary Emoke J. E “Non-Insulin Dependent Diabetes Mellitus among Aboriginal North Americans” Annual Review of Anthropology, Vol. 23 (1994), pp. 457-482 Annual Reviews p.470

[4] Swedlund, Alan. Jennie R. Joe, Robert S. Young “Diabetes as a Disease of Civilization: The Impact of Culture Change on Indigenous Peoples” Medical Anthropology Quarterly, New Series, Vol. 11, No. 1 (Mar., 1997), pp. 118-120 Blackwell Publishing on behalf of the American Anthropological Association p.119

[5] Szathmary Emoke J. E “Non-Insulin Dependent Diabetes Mellitus among Aboriginal North Americans” Annual Review of Anthropology, Vol. 23 (1994), pp. 457-482 Annual Reviews p.472

[6] Swedlund, Alan. Jennie R. Joe, Robert S. Young “Diabetes as a Disease of Civilization: The Impact of Culture Change on Indigenous Peoples” Medical Anthropology Quarterly, New Series, Vol. 11, No. 1 (Mar., 1997), pp. 118-120 Blackwell Publishing on behalf of the American Anthropological Association p.119

[7] “Diabetes Education in Tribal Schools” National Center for Chronic Disease Prevention and Health Promotion, 2009. <http://www3.niddk.nih.gov/fund/other/dets/ index.htm>

[8] Szathmary Emoke J. E “Non-Insulin Dependent Diabetes Mellitus among Aboriginal North Americans” Annual Review of Anthropology, Vol. 23 (1994), pp. 457-482 Annual Reviews p.474

[9] [9] Szathmary Emöke J. E. and R. E. Ferrell “Glucose Level, Acculturation, and Glycosylated Hemoglobin: An Example of Biocultural Interaction” Medical Anthropology Quarterly, New Series, Vol. 4, No. 3, Steps toward an Integrative Medical Anthropology (Sep., 1990), pp. 315-341, Blackwell Publishing on behalf of the American Anthropological Association p.319

[10] [10] Szathmary Emöke J. E. and R. E. Ferrell “Glucose Level, Acculturation, and Glycosylated Hemoglobin: An Example of Biocultural Interaction” Medical Anthropology Quarterly, New Series, Vol. 4, No. 3, Steps toward an Integrative Medical Anthropology (Sep., 1990), pp. 315-341, Blackwell Publishing on behalf of the American Anthropological Association p.334

[11] Szathmary Emoke J. E “Non-Insulin Dependent Diabetes Mellitus among Aboriginal North Americans” Annual Review of Anthropology, Vol. 23 (1994), pp. 457-482 Annual Reviews p.460

[12] Crosby, Alfred W. “The Origins of Native Americans: Evidence from Anthropological Genetics by Michael H. Crawford” Ethnohistory, Vol. 46, No. 1 (Winter, 1999), pp. 187-188 Duke University Press

[13] Szathmary Emoke J. E “Non-Insulin Dependent Diabetes Mellitus among Aboriginal North Americans” Annual Review of Anthropology, Vol. 23 (1994), pp. 457-482 Annual Reviews p.467

[14] Emoke J. E Szathmary “Non-Insulin Dependent Diabetes Mellitus among Aboriginal North Americans” Annual Review of Anthropology, Vol. 23 (1994), pp. 457-482 Annual Reviews p.460

[15] Emoke J. E Szathmary “Non-Insulin Dependent Diabetes Mellitus among Aboriginal North Americans” Annual Review of Anthropology, Vol. 23 (1994), pp. 457-482 Annual Reviews p463

[16] Marchland, Lorraine. 2002. “Obesity and Diabetes: Pima Indians” National Institute of Diabetes and Digestive and Kidney Diseases. <http://diabetes.niddk.nih.gov/dm/ pubs/pima/obesity/obesity.htm>

[17] Szathmary Emoke J. E “Non-Insulin Dependent Diabetes Mellitus among Aboriginal North Americans” Annual Review of Anthropology, Vol. 23 (1994), pp. 457-482 Annual Reviews p.462-463

[18] Szathmary Emoke J. E “Non-Insulin Dependent Diabetes Mellitus among Aboriginal North Americans” Annual Review of Anthropology, Vol. 23 (1994), pp. 457-482 Annual Reviews p.463

History, and Healthcare

For Native American ancestral hunter-gatherers, excess glucose was not a standard part of diets but instead occurred only occasionally under seasonal feasting conditions. Once stored as fat, the energy consumed could be used when food availability later became restricted due to seasonal environmental factors (known as “glucose sparing”[1] among researchers of Arctic Native American populations). In the years following World War II by which Euro-American populations had integrated elements of western culture into every facet of traditional Native American life, altered lifestyle conditions (such as a continuous and ample food supply and the wide availability of motor vehicle transportation requiring little physical activity have led to increased rates of hyperinsulinemia and obesity[2] among Native American populations thus leading to increased rates of NIDM among the already genetically susceptible Native Americans. Ethno-historians such as Jennie R. Joe and Robert S. Young have characterized the genetic propensity of NIDM among Native Americans as the “price of civilization attributable to changes in diet and lifestyle brought about by contact with mainstream Euro-American culture”[3].

Many anthropologists believe that the high prevalence of NIDM among Native American communities is the lack of healthcare availability / utilization among Native American populations. In many instances shown through the research of medical anthropologists such as Peter Wolfson and Virginia Hood, even when healthcare services are available to Native American communities many Native Americans refuse to seek preventative healthcare / treatment for problems such as NIDM due to communication misinterpretations between Native American patients and Euro-American healthcare providers. Wolfson suggests that metalinguistic cues reflecting Native American and Euro-American grammatical and sociolinguistic patterning may be misunderstood by patients and healthcare providers; leading to a myriad of misinterpretations[4]. According to Wolfson, “even when health care providers communicate in ostensibly the same language, differences in modes of behavior and belief and norms of usage may lead to misunderstanding”[5]. The use of silence, indirect / direct question phrasing, eye contact, and metalinguistic cues vary widely between Native American and Euro-American conversation customs, and can be misinterpreted by Native American patients of Euro-American healthcare providers to create an atmosphere of discomfort and confusion to which a Native American patient may not return for further help once such an experience has occurred[6].


[1] Szathmary Emoke J. E “Non-Insulin Dependent Diabetes Mellitus among Aboriginal North Americans” Annual Review of Anthropology, Vol. 23 (1994), pp. 457-482 Annual Reviews p.466

[2] Szathmary Emoke J. E “Non-Insulin Dependent Diabetes Mellitus among Aboriginal North Americans” Annual Review of Anthropology, Vol. 23 (1994), pp. 457-482 Annual Reviews p.464

[3] Alan H. Goodman “Diabetes as a Disease of Civilization: The Impact of Cultural Change on Indigenous Peoples”. Contemporary Sociology, Vol. 25, No. 4 (Jul., 1996), pp. 566-567 American Sociological Association p.566

[4] Woolfson, Peter. “Mohawk English in the Medical Interview” Medical Anthropology Quarterly, New Series, Vol. 9, No. 4 (Dec., 1995), pp. 503-509 Blackwell Publishing on behalf of the American Anthropological Association p.503

[5] Woolfson, Peter. “Mohawk English in the Medical Interview” Medical Anthropology Quarterly, New Series, Vol. 9, No. 4 (Dec., 1995), pp. 503-509 Blackwell Publishing on behalf of the American Anthropological Association p.508

[6] Woolfson, Peter. “Mohawk English in the Medical Interview” Medical Anthropology Quarterly, New Series, Vol. 9, No. 4 (Dec., 1995), pp. 503-509 Blackwell Publishing on behalf of the American Anthropological Association p.505

Organizations and Initiatives

The American Centers for Disease Control and Prevention acknowledges that most instances of diabetes among Native Americans are type two NIDM cases, which are “associated with modifiable risk factors such as obesity and inactivity”[1], thus prevention of NIDM has become a prominent goal for many Native American communities and North American government agencies. In 1997, the American “Balanced Budget Act” provided over one hundred and fifty million dollars in grants to Indian Health Services over the course of the following five years to promote programs which would prevent and treat diabetes among Native Americans; resulting in the creation of over three hundred new NIDM prevention / treatment programs[2].

Dr. Griffin Rodgers of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) stated “We are asking American Indians and Alaskan Natives to fight back because of their increased risk for type 2 diabetes. We’re showing them how to take action to prevent or delay the disease”[3]. Organizations and initiatives such as the National Diabetes Education Program[4], Indian Health Service Division of Diabetes Treatment and Prevention[5], and The National Institutes of Health Office of Science Education[6] have worked extensively together to create educational programs and provide Native American communities with the tools to decrease the risk of NIDM. Similarly, the Diabetes Mellitus Coordinating Committee and the National Institutes of Health has worked cooperatively with the Tribal Leaders Diabetes Committee and the Indian Health Service Division of Diabetes Treatment and Prevention[7] to devise means through which Native Americans can educate and protect themselves from NIDM. The result was the development of “a curriculum that would teach the science of diabetes in tribal schools”[8] known as the Diabetes Education in Tribal Schools (DETS) curriculum. A secondary goal of the DETS curriculum after preventing NIDM is to increase interest in science and healthcare professions among Native American students[9] with the hopes of expanding the amount of medical care available to Native American communities. The increasing number of Native American healthcare providers could also help serve to eliminate the communication problems that have manifested among Native American patients seeking treatment / disease prevention from non-native healthcare providers.

NIDM has become a growing pandemic among Native American populations over the past seventy years. Many sociologists and anthropologists believe that lifestyle changes that followed the Indian Boarding School movement and Reservation Movement of the past two hundred years have led mounting numbers of Native Americans into conditions of increased susceptibility to develop NIDM. Genetic researchers also believe that Native Americans are biologically prone to develop NIDM, thus increasing the already behaviorally induced risk of developing NIDM among Native American populations. Prevention of NIDM has become a major focus of many Native American communities and North American government agencies, and has led to the development of preventative programs such as educational curriculums. Such programs not only address the behavioral patterns which increase the risk of NIDM, but also strive to encourage further participation of Native Americans in healthcare fields to eliminate the communication misinterpretations that prevent so many native Americans from seeking preventative/treatment assistance in monitoring their NIDM.


[1] American Centers for Disease Control and Prevention, “Diabetes Fact Sheet”. Department of Health and Human Services, USA. 2008 <http://www.cdc.gov/diabetes/>

[2] American Centers for Disease Control and Prevention, “Diabetes Fact Sheet”. Department of Health and Human Services, USA. 2008 <http://www.cdc.gov/diabetes/>

[3]TaWanna Berry “MILLIONS OF AMERICAN INDIANS AND ALASKA NATIVES AT INCREASED RISK FOR TYPE 2 DIABETES” National Diabetes Education Program. 2004. <http://ndep.nih.gov/diabetes/pubs/AI-AN_Press_Release_8-04.pdf>

[4] “The Diabetes Epidemic Among American Indians and Alaska Natives” National Institute of Diabetes and Digestive and Kidney Diseases. National Diabetes Statistics, 2007. <http://www.diabetes.niddk.nih.gov/dm/pubs/statistics/>

[5] “Diabetes Education in Tribal Schools” National Center for Chronic Disease Prevention and Health Promotion, 2009. <http://www3.niddk.nih.gov/fund/other/dets/ index.htm>

[6] “Diabetes Education in Tribal Schools” National Center for Chronic Disease Prevention and Health Promotion, 2009. <http://www3.niddk.nih.gov/fund/other/dets/ index.htm>

[7] “Diabetes Education in Tribal Schools” National Center for Chronic Disease Prevention and Health Promotion, 2009. <http://www3.niddk.nih.gov/fund/other/dets/ index.htm>

[8] “Diabetes Education in Tribal Schools” National Center for Chronic Disease Prevention and Health Promotion, 2009. <http://www3.niddk.nih.gov/fund/other/dets/ index.htm>

[9] “Diabetes Education in Tribal Schools” National Center for Chronic Disease Prevention and Health Promotion, 2009. <http://www3.niddk.nih.gov/fund/other/dets/ index.htm>

Special Thanks

Special Thanks to my husband for enabling my research!
Special Thanks to my husband for enabling my research!

Sources

American Centers for Disease Control and Prevention, “Diabetes Fact Sheet”. Department of Health and Human Services, USA. 2008 <http://www.cdc.gov/diabetes/>

Berry, TaWanna. “MILLIONS OF AMERICAN INDIANS AND ALASKA NATIVES AT INCREASED RISK FOR TYPE 2 DIABETES” National Diabetes Education Program. 2004. <http://ndep.nih.gov/diabetes/pubs/AI-AN_Press_Release_8-04.pdf>

Crosby, Alfred W. “The Origins of Native Americans: Evidence from Anthropological Genetics by Michael H. Crawford” Ethnohistory, Vol. 46, No. 1 (Winter, 1999), pp. 187-188. Duke University Press

“Diabetes Education in Tribal Schools” National Center for Chronic Disease Prevention and Health Promotion, 2009. <http://www3.niddk.nih.gov/fund/other/dets/index.htm>

Division of Diabetes Translation, “Trends in Diabetes Prevalence Among American Indian and Alaska Native Children, Adolescents, and Young Adults—1990-1998” National Center for Chronic Disease Prevention and Health Promotion, 2009 <http://www.cdc.gov/diabetes/pubs/factsheets/aian.htm>

Goodman Alan H. “Diabetes as a Disease of Civilization: The Impact of Cultural Change on Indigenous Peoples”. Contemporary Sociology, Vol. 25, No. 4 (Jul., 1996), pp. 566-567 American Sociological Association

Marchland, Lorraine. 2002. “Obesity and Diabetes: Pima Indians” National Institute of Diabetes and Digestive and Kidney Diseases. <http://diabetes.niddk.nih.gov/dm/pubs/pima/obesity/obesity.htm>

Meltzer, David J. Untitled Review, Annual Review of Anthropology, Vol. 24 (1995), pp. 21-45 Annual Reviews

Szathmary Emoke J. E “Non-Insulin Dependent Diabetes Mellitus among Aboriginal North Americans” Annual Review of Anthropology, Vol. 23 (1994), pp. 457-482 Annual Reviews

Swedlund, Alan. Jennie R. Joe, Robert S. Young “Diabetes as a Disease of Civilization: The Impact of Culture Change on Indigenous Peoples” Medical Anthropology Quarterly, New Series, Vol. 11, No. 1 (Mar., 1997), pp. 118-120 Blackwell Publishing on behalf of the American Anthropological Association

Szathmary Emöke J. E. and R. E. Ferrell “Glucose Level, Acculturation, and Glycosylated Hemoglobin: An Example of Biocultural Interaction” Medical Anthropology Quarterly, New Series, Vol. 4, No. 3, Steps toward an Integrative Medical Anthropology (Sep., 1990), pp. 315-341, Blackwell Publishing on behalf of the American Anthropological Association

“The Diabetes Epidemic Among American Indians and Alaska Natives” National Institute of Diabetes and Digestive and Kidney Diseases. National Diabetes Statistics, 2007. <http://www.diabetes.niddk.nih.gov/dm/pubs/statistics/>

Ubelaker Douglas H. “The Origins of Native Americans: Evidence from Anthropological Genetics by Michael H. Crawford” The Journal of the Royal Anthropological Institute, Vol. 8, No. 2 (Jun., 2002), pp. 387 -388 Royal Anthropological Institute of Great Britain and Ireland

Woolfson, Peter. “Mohawk English in the Medical Interview” Medical Anthropology Quarterly, New Series, Vol. 9, No. 4 (Dec., 1995), pp. 503-509 Blackwell Publishing on behalf of the American Anthropological Association

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