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Diabetes in American Indians

Diabetes in American Indians
Author Information (click to view)

Amanda M. Fretts, PhD, MPH

Assistant Professor, Department of Epidemiology
Cardiovascular Health Research Unit
University of Washington, Seattle

Amanda M. Fretts, PhD, MPH, has indicated to Physician’s Weekly that she has received grants/research aid from the University of Washington School of Public Health & the NIH.

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Amanda M. Fretts, PhD, MPH (click to view)

Amanda M. Fretts, PhD, MPH

Assistant Professor, Department of Epidemiology
Cardiovascular Health Research Unit
University of Washington, Seattle

Amanda M. Fretts, PhD, MPH, has indicated to Physician’s Weekly that she has received grants/research aid from the University of Washington School of Public Health & the NIH.

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The American Heart Association (AHA) has implemented 2020 goals for promiting cardiovascular health in a campaign called Life’s Simple 7. These goals are based on the current understanding of modifiable risk factors for cardiovascular disease (CVD) and are up-to-date for the optimization of heart health. The seven goals in Life’s Simple 7 include: 1) a physically active lifestyle; 2) a healthy diet; 3) a healthy BMI; 4) avoiding smoking; 5) lowering blood pressure, 6) reducing fasting glucose; and 7) decreasing total cholesterol.

“The overarching goals of the AHA’s Life’s Simple 7 are to improve the cardiovascular health profiles of all Americans and reduce deaths from CVD by 20% by 2020,” explains Amanda M. Fretts, PhD, MPH. “The strategic plan also highlights racial disparities in cardiovascular health by emphasizing the importance of promoting Life’s Simple 7 in minority populations, including American Indians.” Previous studies have shown that American Indians are a population with high rates of diabetes and CVD.

Low-Risk Health Behaviors & Factors Among American Indians

In an analysis published in Diabetes Care, Dr. Fretts and colleagues used data from the Strong Heart Family Study (SHFS) to examine the associations of low-risk health behaviors and factors—as defined using the Life’s Simple 7 goals—with incident type 2 diabetes among American Indians. The research involved 1,639 SHFS participants without diabetes at baseline and who participated in a follow-up examination. Patients were followed for an average of 5 years. Risk scores, ranging from 0 to 7, were then created using the components of Life’s Simple 7 goals.

According to the results, SHFS participants who achieved at least two of the Life’s Simple 7 goals had a lower risk of diabetes than those who met one or none of these criteria. “Patients achieving two or three of Life’s Simple 7 goals had a 60% lower risk of diabetes when compared with those achieving one or none of the goals,” Dr. Fretts says. Those achieving four or more of the goals had an 89% lower risk of diabetes when compared with participants who only achieved one goal or not of the goals. “Our data suggests that taking even small steps toward achieving Life’s Simple 7 goals can improve outcomes among American Indians,” Dr. Fretts adds.

American Indians: Achieving Diabetes Goals

Dr. Fretts notes that no participants in the study achieved all of Life’s Simple 7 goals, but says it is important that clinicians do not get discouraged. “Physicians should encourage American Indians and other patient populations to try to achieve all of the goals in Life’s Simple 7,” she says. “Even if only a few health behaviors and risk factors are addressed, patients can see a positive impact on their overall cardiometabolic health.”

Readings & Resources (click to view)

Fretts AM, Howard BV, McKnight B, et al. Life’s Simple 7 and incidence of diabetes among American Indians: the Strong Heart Family Study. Diabetes Care. 2014 May 7 [Epub ahead of print]. Available at: http://care.diabetesjournals.org/content/early/2014/05/02/dc13-2267.abstract.

Golay A, Brock E, Gabriel R, et al. Taking small steps towards targets – perspectives for clinical practice in diabetes, cardiometabolic disorders and beyond. Int J Clin Pract. 2013;67:322-332.

Kulshreshtha A, Vaccarino V, Judd SE, et al. Life’s Simple 7 and risk of incident stroke: the reasons for geographic and racial differences in stroke study. Stroke. 2013;44:1909-1914.

Fretts AM, Howard BV, McKnight B, et al. Associations of processed meat and unprocessed red meat intake with incident diabetes: the Strong Heart Family Study. Am J Clin Nutr. 2012;95:752-758.

Mozaffarian D, Kamineni A, Carnethon M, Djouss ´e L, Mukamal KJ, Siscovick D. Lifestyle risk factors and new-onset diabetes mellitus in older adults: the cardiovascular health study. Arch Intern Med. 2009;169:798-807.

Duncan GE, Goldberg J, Buchwald D, Wen Y, Henderson JA. Epidemiology of physical activity in American Indians in the Education and Research Towards Health cohort. Am J Prev Med. 2009;37:488-494.

North KE, Howard BV, Welty TK, et al. Genetic and environmental contributions to cardiovascular disease risk in American Indians: the strong heart family study. Am J Epidemiol. 2003;157:303-314.

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