In a Morbidity and Mortality Weekly Report (MMWR)(www.cdc.gov) posted Jan. 10 as an MMWR Early Release in concert with a CDC Vital Signs report,(www.cdc.gov) the agency highlighted federal data that showed diabetes-related end-stage renal disease (ESRD-D) among Native American adults (American Indians and Alaska Natives) decreased 54 percent from 1996 to 2013.
This substantial reduction came after the Indian Health Service (IHS) implemented population-based approaches to diabetes management and improvements in clinical care in the mid-1980s, the agency noted.
"The Indian Health Service has made tremendous progress by applying population health and team-based approaches to diabetes and kidney care," said CDC Director Tom Frieden, M.D., M.P.H., in a Jan. 10 news release.(www.cdc.gov) "Strong coordinated clinical care and education, community outreach and environmental changes can make a dramatic difference in reducing complications from diabetes for all Americans."
- A Morbidity and Mortality Weekly Report released Jan. 10 in concert with a Vital Signs report showed diabetes-related end-stage renal disease among Native American adults decreased 54 percent from 1996 to 2013.
- The CDC said this substantial reduction came after the Indian Health Service implemented population-based approaches to diabetes management and improvements in clinical care in the mid-1980s.
- About two in three Native Americans with kidney failure have diabetes, but the rate of diabetes-related kidney failure in Native Americans has declined faster than that seen in any other racial/ethnic group.
According to the CDC, diabetes is the leading cause of kidney failure in the United States, and Native Americans have a greater chance of having diabetes than any other U.S. racial/ethnic group. Furthermore, about two in three Native Americans with kidney failure have diabetes, according to the Vital Signs report.
Even so, the rate of diabetes-related kidney failure in Native Americans has declined faster than that seen in any other racial/ethnic group.
In the CDC news release, Mary Smith, IHS principal deputy director, echoed Frieden's remarks about population-based approaches and enhancements in clinical care having been essential to securing the gains made.
"We believe these strategies can be effective in any population," she noted. "The patient, family and community are all key partners in managing chronic diseases, including diabetes."
According to the CDC, Medicare covers ESRD treatment for beneficiaries regardless of age and pays most of the cost of ESRD treatment in the United States. The U.S. Renal Data System (USRDS) is a surveillance system for ESRD based on clinical and claims data reports to CMS.
Because most patients with ESRD become eligible for Medicare coverage after 90 days of ESRD treatment, only data on patients who have been treated for at least 90 days were included in the data set.
For each year studied, USRDS data were used to determine the number of U.S. adults 18 and older who began treatment (dialysis or kidney transplantation) for ESRD-D. Data were analyzed for Native Americans, as well as for white, black and Asian population groups.
ESRD-D incidence was calculated using the number of newly treated ESRD-D cases and two population estimates for each racial and ethnic group:
- total population from U.S. Census figures from 1996 to 2013, and
- population with diagnosed diabetes during the period 2006-2013.
The number of Native Americans with diagnosed diabetes was calculated using age- and gender-specific prevalence estimates from the IHS National Data Warehouse for 2006-2013 and multiplying them by annual bridged single race population estimates for Native Americans from the U.S. Census; 2006 was the first year for which consistent prevalence data were available.
Measures of care for Native Americans with diabetes were obtained from the IHS Diabetes Care and Outcomes Audit, including prescription of ACE inhibitors and angiotensin II receptor blockers; blood pressure; hemoglobin A1c to assess glucose control; and urine albumin-to-creatinine ratio testing for identifying and monitoring diabetic kidney disease.
Other Key Findings
Aside from the substantial decrease in kidney failure from diabetes seen in Native Americans since 1996, other aspects of IHS-supported care for diabetes in this population have improved during that time. For example,
- use of medication to protect kidneys increased greatly, from 42 percent to 74 percent in five years;
- average blood pressure in Native Americans with diabetes and hypertension has been brought under control (133/76 in 2015);
- blood sugar control improved by 10 percent between 1996 and 2014; and
- more than 60 percent of Native Americans 65 and older who have diabetes had a urine test for kidney damage (2015) compared with 40 percent of the overall Medicare diabetes population (2013).
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