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The epidemic of type 2 diabetes is a global phenomenon. Populations in the disadvantaged and minority communities in the developed countries, as well as the populations in less developed countries, are at a greater risk. It is believed that changes in the way of life among the populations that is essentially characterized by increased calories; diminished physical activity, increased obesity, and excessive intake of fat have actually interrelated with genetic factors to increase the susceptibility to the diabetes epidemic (Swisher 94).

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In United State of America, the occurrence of diabetes among American Indians was actually almost unknown in the early 1940s. Diabetes started appearing among the Northern American Indians during the early 1960s, and it has essentially developed into a health condition. The prevalence of diabetes among the North American Indians exploded in early 1970s, and today is a pandemic. During the year 1990, almost every North American Indians was involved with diabetes directly or indirectly through friends or family members (Swisher 107).

In the last 10 years, there has been an increasing concern about the diabetes epidemic among the Northern American Indians; the epidemic has attracted the attention of both American and the entire international medical community. The American Indian communities and the Indian Health Service have organized numerous conferences in an attempt to pinpoint the underlying factors and propose a long lasting solution to the people of North American Indian population (Bethesda 49).

Hypothetically, the lifestyle and social conditions of the North American Indians population along with the fundamental hereditary susceptibility are the main factors that contribute to the increase in prevalence of the type 2 diabetes among the North American Indians population in United State of America (Bethesda 78).

Diabetes type 2 is a prolonged illness that normally requires a permanent medical care and ongoing self-management education and patient support in order to evade the acute difficulties and complications, and also to reduce the risk of long term complications. Care to a diabetic is normally a complex issue that requires multi-intervention strategies that normally go beyond glycemic monitoring and control. But low economic and social aspects among the North American Population worsen the already worst condition. This makes early prognosis among the northern American Indian population and subsequent interruption of the onset of diabetes a challenge (Bethesda 92).

The epidemic of non-insulin dependent diabetes in native North American Indians has primarily occurred during the second half of the previous century. Although this type of diabetes has a hereditary component, that is highest in the full-blooded Native American, the frequency, and the prevalence of this type of diabetes have dramatically increased as the North American population who have in reality abandoned their traditional lifestyles in favor of westernization. This western civilization accompanies a vivid increase in the gross body mass index as a result of poor diet and diminished physical activity (Swisher 148).

Various anthropologic studies indicate that, many tribes in North America initially perceived diabetes as an assault from the external communities. Diabetes was once labeled as a non-threatening disease of North American Indians; in modern days, diabetes and its complications are widely considered as the main cause of mortality and morbidity in all Northern American populations, with an exception of the isolated Arctic individuals, whose way of life has remained relatively unchanged (Swisher 67).

Insulin dependent diabetes is normally infrequent among the Native North American Indians population, and it is usually found among individuals with a substantial non-Native American ancestry. Much understanding of the natural history of non-insulin dependent diabetes that is commonly prevalent among North American population has been derivative from the longitudinal epidemiologic studies of the Pima Indians in southern Arizona (Bethesda 47).

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There is a connection between obesity and diabetes that is known to be prevalent among the Northern American population. Although the prevalence of cardiovascular diseases normally varies from population to population, these differences normally reflect genetically based disparities in coronary risk factors and lipid metabolism or variances in lifestyles. Native American communities have been found to experience remarkably high rates of micro vascular problems resulting from diabetes (Bethesda 103).

The extent and prevalence of diabetes in Northern American Indians communities requires a public health intervention programs that fully incorporates explicit cultural and psychosocial adaptations for Northern American Indians communities.

The studies on diabetes that were conducted in Native American Indians since early 1960s have provided an outstanding and extensive information about diabetes type 2 and its natural history in the North American Indian population. The major form of diabetes that normally distresses people in that region is normally characterized immunologically and biochemically as non-insulin dependency diabetes mellitus. This observation confirms the scarceness of insulin dependency diabetes Mellitus in the other tribes (Parker 64).

Diabetes rates are typically highest in full blooded Native American Indian; this was first detected in the Choctaw Indians in 1965 and afterward in other tribes. The occurrence of diabetes among the residents of the North American Indian community has been found to be highest in those individuals who are of full Native American Indian heritage. Furthermore, diabetes prevalence rates among American Indians are usually highest in the offspring of the parent who actually developed diabetes at their young age. This observation clearly indicates that genetics and the entire family lifestyle predispose an individual to non-insulin dependency diabetes mellitus.

Even though, the hereditary component of non-insulin dependency diabetes mellitus has not been precisely described among the American Indians, a hereditary marker connected with the insulin resistance, which is essentially a crucial element in pathogenesis of non-insulin dependency diabetes mellitus has been evident amongst North American Indian community (Parker 103).

The way of life among the Northern American community has been profoundly influenced by western civilization. A significant change has been noted in the change of dietary pattern and diminished physical activity among the native Northern American Indians over the recent decades. Even though a detailed survey of the change is unavailable for most communities, the interruption of the traditional agricultural patterns and hunting has resulted to excess consumption of bad fat, which is common in contemporary western diet.

In the North American Indian population, consumption of excessive fat, which consequently leads to the presence of high calories in the body, has been associated with the development of diabetes amongst the population. Initially, the intake of carbohydrates was the single strongest predictor of the occurrence of non-insulin dependency diabetes mellitus, but later it was closely connected to the total amount of calorie and fat consumed by an individual.

Physical activity among the North American Indian population has reduced significantly as many individuals have resorted to a motorized transportation mode and inactive, sedentary occupations. Diabetic Northern American individual reported as having remarkably less lifetime physical activity as compared to no-diabetic individuals. A recent case control study in North American Indians indicated that the risk of being diagnosed with diabetes reduced with an increase in physical activity. The study further revealed that the risk of non-insulin dependency diabetes dropped significantly independently of the individual body weight (Parker 146).

A study on the pathogenesis of non-insulin dependency diabetes in Northern American Indian population clearly indicates that the insulin resistance, as it has been measured using non-oxidative glucose disposal, is actually an early metabolic defect. Further investigation reveals that insulin secretion and resistance increases as an individual develops compromised glucose tolerance. Insulin levels have also been found to fall as the non-insulin dependency diabetes develops, often at a moderately young age (Parker 134).

Obesity is another key risk aspect for non-insulin dependency diabetes in the North American Indian population. This had been due to the increase in obesity rates as measured across several communities in North American population. Various studies among the people on North American Indian have indicated that there is indeed an interaction between obesity and hereditary susceptibility to non-insulin dependency diabetes. There has been a remarkable increase in obesity among the northern American population over the recent years. In addition, longer period of obesity has been proved to elevate the risk of diabetes among the Native American Indian communities (Parker 154).

Central obesity has been a typical in the study of the underlying cause of non-insulin dependency diabetes in the region. In young American Indian, hip to waist ratio is usually used as a scale for measuring the central obesity, for this ratio has been strongly interlinked with the occurrence of the non-insulin dependency diabetes mellitus than the body mass index. Small research has also established that having an increased waist to hip ratio significantly increased the risk of developing non-insulin dependency diabetes (Parker 149).

Studies on energy breakdown and the obesity have been done among the northern American Indian population in an attempt to depict presence of a thrifty gene. Even though, the exact cause of obesity among the American Indians has not been precisely explained, studies in North American Indian population have established that low metabolic rates to be interlinked considerably with the weight gain. Comprehensive metabolic studies have also shown that susceptibility to obesity and non-insulin dependency diabetes mellitus to be widespread within the American Indian population. This has been associated to sporadic change from traditional high carbohydrate diets to modern high fat diets that are abundantly evident among the American Indian population (Parker 213).

Modern-day high fat content diets have closely been associated with the deterioration of the carbohydrates metabolism in the North American Indians population. The current understanding of the diabetes epidemic in the Native American Indians has been largely been based on the studies conducted in the North American Indian populations. The relationship between genetic susceptibility and environmental changes to non-insulin dependency diabetes is not only limited to the indigenous northern American Indian population but it is also widespread to other population in the world (Parker 65).

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Health complications that stem from diabetes among North American Indians

The end stage renal diseases registries in the United States of America indicates that the North American Indian population is at a considerable higher risk for entering treatment for the kidney failure. The statistical records at the End stage renal diseases indicate that during the years 1981 to 1986, the North American Indians population was approximately 4 times likely to develop kidney failure as a result of diabetes than the white. The natural history of the diabetic kidney diseases in North American Indian population has well been defined. Both explicit diabetic nephropathy and the end stage renal diseases increases as the period of diabetes increases. Hyperglycemia and high blood pressure normally predicts the development of an explicit nephropathy. Likewise, hypertension and fasting blood glucose has been found a substantial risk factor for the development of renal failure among the North American Indian population (Bethesda 47).

Furthermore, diabetic offspring who have at least one parent with proteinuria and diabetes are at a considerable greater risk of developing nephropathy compared to those diabetic offspring whose parent never had proteinuria. The epidemiologic and clinical studies indicate that the natural history of diabetic nephropathy in North American Indians is much comparable to the diabetic nephropathy in those individuals with insulin dependent diabetes mellitus (Bethesda 56).

Periodontal diseases have also been found to be a significant health complication among the North American Indian as a result of diabetes. Periodontal disease rates in North American Indians have been reported to be 2.6 times higher in those patient who are diabetic than in those who are non-diabetic. In addition, destructive periodontal diseases have been found to be more severe in those patients who are diabetic. The rate of reappearance of edentulousness has been found to increase evidently with diabetes duration. At the duration of 20 years, approximately 75 percent of the diabetic in the North American Indian population were edentulous. Furthermore, the presence of poor glycemic control and retinopathy has been found to elevate the risk of developing periodontal disease (Bethesda 123).

Even though, the pathogenesis of an infection as a complication of diabetes is not that simple, it is explicit that infections are of particular significance in Native North American Indian population. Tuberculosis death in American Indians in 1987 was found to be 5.8 times greater than the rates for all races in United States of America. In a controlled case study in North American Indian population, diabetic individuals were found to be 4.4 times more probable to develop tuberculosis compared to non-diabetic individuals. Hence, those infections that are closely linked to diabetes in North American Indian population are typically of specific concern to the population of that region. (Bethesda 86).

Diabetes and gallbladder diseases have been closed been associated together with the North American Indian population as being a new world syndrome with both evolutionary and genetic foundation. In an investigation of gallbladder diseases in North American Indian population within a period of 20 year, there was no excess danger of death that was actually found in those diabetic individual with gallstones as compared to those individual with ordinary glucose tolerance and gallstones. Nonetheless, North American Indians with gallstones experienced both elevated death from the gallbladder and cancer. Inclusive cancer and gallbladder death data indicated a slight significance difference between non-diabetic and diabetic with diabetic having more death (Bethesda 112).

The cases of visually disabling cataracts have been found to be higher in North American Indian population as compared with the whole of the United State population. After the sex and age was controlled in North American Indian population, individuals who were diabetic were found to experience 2 times more cataract extraction as compared to non-diabetic individuals. The rates of cataract surgery rates have been found to be elevated with longer duration of diabetes and in those individuals who are treated with insulin (Bethesda 69).

Even though, knowledge of the epidemiology of cardiovascular ailments is still incomplete, various studies on Northern American Indian population indicate that diabetes is a key risk element for the development of cardiovascular diseases in Native American populations. The understanding of cardiovascular diseases in North American Indians population and its relationship to diabetes is evolving. The rate of ischemic heart disease and strokes in the region has been found to equal or exceed the American national rates in recent years. Further studies indicate that all disastrous coronary events in North American Indian region during the year 1975 to 1984 were on diabetic individuals. In this region, report notes an exceptionally close relationship between myocardial infarction and diabetes (Bethesda 187).

The limited statistical data on hypertension in North American Indian population appear to be slightly higher than that of general American population. A sample of American Indian in the region had an elevated blood pressure compared to the overall American population. The comparative risk of being diagnosed with hypertension is higher in a diabetic individual, compared to non-diabetic individuals, and normally ranges from 4.7 to 7.7 according to the Indian Health Service survey in the region. In addition, published data on stroke rates in diabetic American Indians indicates that there is paucity. Stroke connected mortality does not show variation between those with normal glucose tolerance and those individual who are diabetic. However, stroke cases among the native North American Indians have been found to be slightly more than rates found in white diabetic population (Bethesda 198).

Studies on human nature of modernization indicate that weight gain and obesity prevalence has actually increased with spread of modernization of the North American Indian population. Studies show that when modernization occurred among the North American Indian population, traditional agricultural patterns and diet as well as physical activities that were normally based on local subsistence were significantly disrupted. Instead, people resorted to a diet of purchased foods backed by waged employment occupations. This to great extent reduced physical activities among the North American Indian population. According to the recent studies, this change towards western or modern diets and inactive, sedentary activities have actually given rise to positive energy balance with a considerable increase in adiposity and body weight (Dixon 38).

The modern diet among the North American Indian population has changed in content. Protein values have been replaced by a high fat diet, minerals and vitamin contents have changed dramatically due to the scarcity of the fresh agricultural produce since the majority of the population has left agricultural activities in favor of sedentary occupations (Dixon 56).

Over the decades, one of the major changes in the North American Indian population diet has been from the consumption of more complex carbohydrates to a low molecular weight and simple refined sugars. This has considerably increased the susceptibility of the North American Indian population, especially with regard to their genetic make-up, which makes them more vulnerable to non-insulin dependency diabetes mellitus. There has not only been a change on the kinds of carbohydrates consumed by the North American Indian population, but the recent development indicates that replacing sugar with non-nutritive inducements has grown enormously (Dixon 76).

During the past few decades, various non-nutritive sweeteners have been availed in the North American Indian population as a result of modern civilization. They include aspartame, cyclamates, alitame, acesulfame, stevioside, theumatin and sucralose. All these so called dietetic foods have been widely marketed to people of the North American Indian population. These non-nutritive sweeteners have replaced the traditional sugar that was considered to be harmless. The calorific content actually decreases, and the fat content increases in the body as a result of consumption of these non-nutritive sweeteners. This has been reported to elevate the vulnerability of the North American Indian people to non-insulin dependency diabetes mellitus (King 56).

Furthermore, modernization in North American Indian population has been found to lessen the amount of physical activity, consequently, the lack of enough body exercise as a result of adoption of sedentary lifestyles has been found to be a main contributory factor to the occurrence of the non-insulin dependency diabetes mellitus in North American Indian population. As modernization progresses considerably in North American Indian population over the decades, their daily life has drastically been transformed. For instance, watching movies and television, riding in a vehicle and playing games with computers, which actually require an exceedingly little muscle movement have been embraced; many North American Indians usually engage in at least one of these inactive activities.(King 78).

It has been reported that insulin receptor on the peripheral muscles cell of individual with non-insulin dependency diabetes mellitus normally becomes more sensitive  to combining the circulating insulin with increasing activity. The studies further indicate that the total insulin secreted by pancreases as a response to glucose levels in the blood actually decreases with the decrease in amount of physical activity. Therefore this reduces the hyperinsulinemia and its complementary metabolic effects. This has been found to be the case for most individual with non-insulin dependency diabetes mellitus in North American Indians population (King 94).

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From the year 1960s, diabetes has inexplicably affected American Indians and Alaskan natives as compared to other Populations. Diabetes is a key cause of morbidity for instance kidney failure, blindness, cardiovascular diseases and lower-extremity amputation as well as premature death among the Northern American population. This information on the prevalence of diabetes among the northern American population has been evaluated from the Indian Health service national outpatient records. These records were actually contrasted with the records of diabetes prevalence among non-Hispanic Caucasians in the United State of America. The analysis of these findings indicates that the commonness and prevalence of diabetes among the Northern American and Alaskan population remains remarkably high. The study provides a predominance rate of approximately three times the frequency of diabetes among non-Hispanic Caucasians in the United States of American (Albuquerque 45).

According to the out-patients records of Indian Health Service, an estimated 63,400 American Indians who received medical care at the Indian Health Service had diabetes. The records indicate that 98.3 per cent were aged 20 years and above. Of those who were aged 20 years and above, 49.7 per cent were within the age bracket of 45-64 years, out of this population 59.0 per cent were women. The statistical analysis findings further indicates that the occurrence of the diabetes increased from 3.5 per cent  for those within the age bracket of 20-44 years  to approximately 21.5 per cent for those aged 65 years and above. The Diabetes prevalence among American Indian was remarkably adept among women with approximately 10.1 per cent more than men who had a prevalence rate of 7.7 per cent. The age definite prevalence among American Indian women was a notch higher than that of men, but in age specific groups among the non-Hispanic white was found to be higher among men than in women.

Diabetes prevalence among American Indians within the age bracket of 20-44 years and that one of 45-64 years was found to be more than three times amongst the non-Hispanic whites. Amongst American Indians individuals aged 65 years and above had prevalence of 21.5 per cent, which is approximately two times the prevalence rate among non-Hispanic whites. Within the age adjusted, prevalence among American Indians of age 20 years was found to be 2.8 times more than that of non-Hispanic of the same age group (Albuquerque 78).

The prevalence of diabetes among the American Indian is usually varied by the clannish groups, with plains tribes having 12.7 per cent, woodland tribes 9.3 per cent, southwestern tribes 10.3 per cent, and pacific tribes having 4.5 per cent respectively.

The mortality rates from diabetes among the North American Indian population have been unusual, even though it has seriously been underestimated in the United States significant statistical data. Statistical figures indicate that death rates in the year 1986 -1988 showed that the age adjusted American Indians death rate was approximately 2.7 times the rate of the common United State population. These data only accounts for cases on which diabetes was the fundamental cause of death and not in those cases where diabetes was a contributing cause (Albuquerque 104).

Mortality rates provided by the Indian Health Service indicate that during the year 1984-1986, there were an approximately 708 death with diabetes being the underlying cause and about 1252 death with diabetes being a contributing cause of death. Furthermore, the National mortality follow back study established that North American Native heritage was actually underreported on the death certificate by 65 percent. When the underreporting was adjusted it was found that diabetes mortality for the North American Indians was actually 3.6 times the diabetes death cases among the whites (Albuquerque 137).

Native North American Indian population lifestyle has been adversely influenced through modern civilization and modernization. This condition has forced the Native American population to shift their focus from traditional agricultural activities to modern sedentary lifestyle that has made Native American became more prone to diabetes. This has been as a result of reliance on the use of government commodity food that is well known to contain high starch and calories quantities. The current trend of consuming fast food in the recent years has actually reinforced the unwholesome food trend in the North American Indian population, a phenomena that never existed several decades ago (Bethesda 56).

Before the arrival and introduction of modern civilization by the white man in America, native people in North American Indian had a rich culture, but the modern lifestyle in the region has made indigenous activities a thing of the past. Instead, it has ushered in a more inactive and sedentary lifestyle. It is evident that native American Indian is probably the group in America that has lost most of their traditional diet to a greater extent. Consequently, judging by their rate of diabetes prevalence, there is actually no other group in America that has paid greater price than the Native American Indian population due to diabetes.

North American Indian population has significantly changed their diet over the years; many people in the population have actually abandoned their foraging, farming, and hunting. They have actually resorted to heavily processed and commercialized way of eating. The westward expansion of the United State of America essentially created Native American reservations. Most of the people in the North American Indian struggle with poor health and poverty as a result of arrival of the white man. This had made more than a third of the people in the region survive on the manufactured diet that is issued by the government (Bethesda 83).

The traditional diet that was once rich in fiber and lean protein have been replaced by the modern government diet that is saturated with fat, carbohydrates, calories and sodium. As a result of consumption of this deprived diet and having limited understanding on the consequence of this poor nutrition, has witnessed a strange increase in the rates of diabetes, cancer, obesity and heart diseases cripple the already depressed North American Indian population, with diabetes topping the mortality list (Bethesda 96).

Although the people in the region have tried to revert to their traditional diet, modern vegetables that actually serve as an important alternative to the canned and processed food products are, in fact loaded with hormones, pesticide and other lethal chemicals that are known to elicit diabetes. Food crops that were used by North American Indian population before the arrival of modern civilization were much more wholesome and beneficial because they were not altered, bleached or contaminated with chemicals. The changes in farming patterns among the North American Indian population have taken away the nutritional value of the most foods that were initially considered to be vital to the health of the people in the region.

Though, North American Indian population had a rich history of prosperous agricultural economies and a healthy food system. All this changed the moment colonization was established by the white man. The indigenous American Indians were driven out of their traditional homelands, and were finally contained in city slums or reservations. On numerous reservations, nutritional deficiencies and malnutrition were actually endemic. In spite of on numerous recommendations, to advance the Native American Indian diets, food supply to this reservations remained to be of poor nutritional quality. Furthermore, the food aid provided did not actually include any of the traditional foods, hence leading to further deterioration of the people’s health. This made them is more vulnerable to diabetes, bearing that Native American genetically are more susceptible to diabetes (Bethesda 104).

It’s crucial to note that there has been an evident difference between the kind of food consumed before and after the arrival of the white man. The change of eating pattern is the key underlying factor that has triggered sporadic development of diabetes among the North American Indian population. Traditional ways of getting food in the region involved gathering, hunting with some farming, the main part of the traditional diet comprised of a protein food sources that were virtually salt free. Furthermore, the Native American Indian consumed a small amount of natural sugar mainly composed of stevia and honey. The people of North American Indian also engaged in numerous physical activities such as hunting, games and dance, physical labor on their farm that was on a daily basis and walking when gathering food. This is the main reason why diabetes among Native American Indians was virtually unknown before the coming of the white man (Bethesda 164).

In contrary, the diet adopted after the arrival of the white man involved excessive fat intake that made up 31-47 percent of calories in the diet, food portion that are typically large but non-nutritive, diet with exceptionally low fiber, fruits and vegetables. Furthermore, there has been the consumption of processed food from government commodity food programs. In addition, the current physical activity in the North American Indian region is mostly sedentary. This brings the Native American Indians population be at higher risk of developing diabetes and other chronic complications that arise as a result of diabetes (Bethesda122).

In the North American Indian population, traditional methods of eating which were always much healthier and physical activities were part of their daily life, are now being utilized by the large population in the region, since the risk of developing diabetes is threatening their well-being, as well as their existence.

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