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SPIRIT LAKE SPECIAL DIABETES PROGRAM FOR INDIANS:“A SACRED LIFE CENTER”

IMPACT OF NUTRITION AND EXERCISE ON HEALTH

A SACRED LIFE CENTER:ROOTS, REASONS, DEVELOPMENT

Tracy Charboneau, MSN RN/ManagerChallsey Scallon, MSN RN/Coordinator

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INTRODUCTIONt1t2t26

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HEALTH PROMOTION

• “Health promotion is behavior motivated bythe desire to increase well-being and actualizehuman health potential” (Pender, 2011, p.5)

PUBLIC HEALTH POLICY• Health equity• Health disparities• Social determinants of healtht30

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HEALTH EQUITY

“everyone has the opportunity to attain his or her full health potential and no one is “disadvantaged” from achieving this potential because of social position or other socially determined circumstances”(CDC, 2017)

HEALTH DISPARITIES

• “a particular type of health difference that isclosely linked with social, economic, and/orenvironmental disadvantage”

(Healthy People 2020, 2017)

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HEALTH DISPARITIES RELATED TO DIABETES

• Native Americans have the highest rates ofType 2 diabetes in the United States,compared to their non-Native counterparts(ADA, 2017)

• Native Americans are 2.2 times more likely todevelop Type 2 diabetes compared with non-Hispanic whites (ADA, 2017)

NATIVE AMERICANS AND DIABETES

• Native Americans are 2.3 times more likely tohave diabetes than non-Hispanic whites

• Native American children ages 10-19 are ninetimes more likely to be diagnosed with Type 2diabetes than non-Hispanic whites

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NATIVE AMERICANS IN NORTH DAKOTA

• As of 2017, it was reported that there are31,329 Native Americans living in North Dakota(North Dakota Indian Affairs Commission, 2017)

• The total number of people in North Dakotawho have a diagnosis of Type 2 diabetes is49,000 (North Dakota Report on Diabetes, 2016)

• 15% of Native Americans living in ND reportedthey have been told they have diabetes

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SPIRIT LAKE AND DIABETES

• In 2016, there were 2,069 enrolled members ofthe Spirit Lake Nation living on the reservation

• In 2016, IHS reported they were providingservice to 5,000 enrolledmembers/descendants of all tribes

• The diabetes audit report shows that there arecurrently 607 people registered on thediabetes registry (Spirit Lake Health Center, 2017)

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COMPLICATIONS OF DIABETES IN NORTH DAKOTA

• Native Americans living in North Dakota aredying 1.6 times more than non-NativeAmericans

• Blindness• Kidney Disease• Heart Disease• Stroke• Amputations

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MAJOR COMPLICATIONS OF DIABETES AT SPIRIT LAKE

• Foot complications: neuropathy, amputations• Kidney disease: nephropathy/dialysis• High blood pressure, which can lead to stroke,heart attack, retinopathy, and kidney disease

• Heart disease• Skin problems(ADA, 2017)

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REASONS FOR A SACRED LIFE CENTERt5t34t35

DEVELOPMENT OF A SACRED LIFE CENTER

• The Diabetes Prevention Program (DPP)• Lifestyle classes• Highly successful lifestyle intervention program• 1,079 participants• 45% of participants were racial and ethnicminorities

• Resulted in a 58% reduction in incidence ofdiabetes

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DPP CONTINUED

• The methods used included:• Lifestyle coaches• Frequent contact with participants• 16-session core curriculum• Supervised physical activity sessions(NIH, 2002) t45

LIFESTYLE COACH TRAINING

• Spirit Lake hosted the first ever Lifestyle CoachTraining for all tribes in North Dakota

• 40 newly certified Lifestyle Coaches• Included IHS Diabetes Program, CommunityHealth Representatives, and other SDPI’s.

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LEVELS OF PREVENTION

(Astro Health, 2013)

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BEST PRACTICES

• SDPI Community-directed grants choose oneBest Practice

• Focus on areas of diabetes prevention andtreatment outcome

(IHS, 2017)

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SDPI DIABETES BEST PRACTICES

Aspirin or other antiplatelet therapy incardiovascular diseaseBlood pressure controlChronic kidney disease screening andMonitoringDental examDepression screening

SDPI BEST PRACTICES CONTINUED.....

Diabetes-related educationEye exam-retinopathy screeningFoot examGlycemic controlImmunizations: hepatitis BImmunizations: influenza

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BEST PRACTICES CONTINUED……

Immunizations: pneumococcalImmunizations: tetanus/diptheriaLipid management in cardiovascular diseaseNutrition educationPhysical activity educationTobacco use screening

SPIRIT LAKE SPECIAL DIABETES PROGRAM FOR INDIANS

• Best practice selected• Diabetes-related education

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CULTURAL VALUES

• Humility• Truth• Courage• Honesty• Respect• Love• Wisdom

(Spirit Lake Nation, 2014)

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WHAT SHOULD WE NAME THE FITNESS CENTER?

A Sacred Life Centert8

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Winning entry for the name, submitted by Mrs. Lonna Street

Winning logo submitted by Mr. Dallas Dogskin

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OVERALL SUCCESS STORY

• Renovation• Sacred Life Center

• Long-term goal is to decrease newly diagnosed patients byat least 50% within 5 years through nutrition education andphysical activity

• Gardening Project• Mini-grant awarded by the American Association of Indian

Physicians (AAIP)• Healthy Active Native Communities (HANC) grant

• Starter gardens• Recycled wooden pallets & totes• Classes for 50 families

A Sacred Life Center Staff

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Challsey Scallon, RN, MSN Tracy Charboneau, RN MSN

INDIVIDUAL SUCCESS STORIES

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CODY GREYWATER

• Cody has been comingto A Sacred Life Centersince the doors opened

• He was our 1st FitnessMember of the Month,

• He is determined toprevent diabetes aslong as possible

DERRICK IRONHAWK-Type 2 Diabetes for 14 years-Double amputee for two years-Recently decided to change his life-Hard work and dedication-Walked for the first time in two years

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VICKI GOURNEAU

• 65 years old• Drives 20 miles oneway every day tocome work out

• Dropped clothingsizes

• Decreased A1c

KAYLA ROBERTSON• “The thought of having diabetes scared me so much that I started walking everyday and tried to

cut out certain food and it worked for awhile I lost 37 pounds.”• “But then it got cold out and the wellness centers didn’t have a lot of equipment to work with. Not

only that, I didn’t really know how to use the equipment they had. I didn’t’ know what kind of workout to do with the equipment and how long to do a workout. So, by the next year I gained allthe weight back and more.”

• “After the Sacred Life Center opened I really didn’t go because I was thinking I don’t know how touse the equipment. After going there, they had me fill out a questionnaire and asked me questions. I didn’t really expect it to be like that.” “The staff were very helpful and worked withme.”

• “Now that I am setting goals for my eating habits and figuring out more ways to be active, it reallyhelps. Little things do make a difference in trying to live a more healthy and active life.”

• “The Lifestyle classes also taught me how to track my food. By learning how much calories, fatgrams, and carbs are in certain foods, it helped me a lot. I started losing more weight by just doingthat.”

• “Going to the Sacred Life Center really did change my life because all the help and information Ireceived from the center, I put it to use. Every day I workout and eat right, I am walking away from Diabetes!”

• “Thank You to all the staff that helped me and kept me motivated!”

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PICTURES

Deb Wilson, MS & Barb Anderson, BSW

RAIN Program Director & Coordinator

Gayle Roux, PhD, NP-C, FAAN

Dean & Professor

UND College of Nursing & Professional Disciplines

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Dr. Chris Burd, RN, PhD

QUESTIONS?

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REFERENCES• American Diabetes Association (2017). Complications. Retrieved from: http://www.diabetes.org/living-

with-diabetes/complications/?referrer=https://www.google.com/• American Diabetes Association (2017). Treatment and care for American Indians/Alaska Natives.

Retrieved from: http://www.diabetes.org/living-with-diabetes/treatment-and-care/high-risk-populations/treatment-american-indians.html?referrer=https://www.google.com/

• American Nurses Association (2017). Public Health Nursing. Retrieved from:http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/PublicHealthNursing

• Astro Health (2013). Leavell and Clarke’s Levels of Prevention. Retrieved from:https://astrohealth.wordpress.com/leavell-and-clarks-levels-of-prevention/

• Caps, R. (2015). Type 2 diabetes continues to plague Indian reservations, new hopes are scarce.Diabetes Health. Retrieved from: https://www.diabeteshealth.com/type-2-diabetes-continues-to-plague-indian-reservations-new-hopes-are-scarce/

• Centers for Disease Control and Prevention. (2015). Use of culturally focused theoretical frameworks foradapting diabetes prevention programs: A qualitative review. Preventing Chronic Disease: Public HealthResearch, Practice and Policy. Retrieved from https://www.cdc.gov/pcd/issues/20151140421.htm .

• Centers for Disease Control and Prevention (2017). Chronic Disease Prevention andHealth promotion. Retrieved from: https://www.cdc.gov/chronicdisease/healthequity/index.htm

• ExploreHealthCareers.org (2017). Public health nurse. Retrieved from:https://explorehealthcareers.org/

• HealthyPeople.gov (2017). Disparities. Retrieved from:https://www.healthypeople.gov/2020/about/foundation-health-measures/Disparities

• IHS Diabetes Care and Outcome Audit (2017). Indian Health Service (IHS).• Indian Health Service (2017). Special diabetes program for Indians. Retrieved from:

https://www.ihs.gov/sdpi/• Frans, M., Boucher, J., & Evert, A. (2014). Evidence-based diabetes nutrition therapy:

Recommendations are effective: The key is individualization. Diabetes, Metabolic Syndrome, andObesity: Targets and Therapy, 7, 65-72.

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• Gittlesohn, J., and Rowan M. (2011). Preventing diabetes and obesity inAmerican Indian communities: The potential of environmentalinterventions. American Society for Nutrition. Retrieved from:http://ajcn.nutrition.org/content/93/5/1179S.full.pdf+html

• Knowler, W.C., and Ackerman, R. T., (2013). Preventing diabetes inAmerican Indian communities. American Diabetes Association. Retrieved

from http://Icare.diabetesjournals.org/content/3617I1820.full-text.pdf. • Pender, N. (2011). Health Promotion in Nursing Practice. 6th Ed. Upper

Saddle River, New Jersey. Pearson Education. • Spirit Lake Nation, 2014. Retrieved from:

http://www.spiritlakenation.com/