Cherokees fight diabetes by thinking in small steps

TAHLEQUAH — In the fight against diabetes, the Cherokee Nation acts big by thinking small.

Instead of initiating a sweeping program in its 14-county jurisdiction in Northeastern Oklahoma when it received a large increase in diabetes-related federal funds six years ago, the tribe went the opposite direction.

It now assists community centers and schools financially and reaches out elsewhere, signing up as many people as it can to walk, run, dance, hike, and learn to cook and eat better.

As many as 30 percent of Cherokees are diabetic.

"I wish I knew the amount of money we spent — direct medical expenses — on diabetes; I don't have the number for that, but it's huge,” said Diabetes Program Director Teresa Chaudoin, who came to work for the tribe in 2001, after completing a master's degree in public health at Johns Hopkins University in Baltimore.

Loosely described, the tribe's diabetes program has 15 components, including testing the blood sugar of anyone at risk of diabetes — being American Indian is considered a risk factor — who visits the tribe's eight clinics, and fitness- and nutrition-related outreach and education.

Once a patient is diagnosed with diabetes, he or she is signed up for five sessions with a dietitian and others in the tribe's Diabetes Self-Management Education Program.

"We try to get everybody that is newly diagnosed into this program,” Chaudoin said, calling the approach "opportunistic screening.”

In 2001, the tribe had two certified diabetes educators; it now has 10. Diabetes educators must have 1,000 hours of patient education during a two-year period. A $6 million annual grant pays for the diabetes program. Earlier this year, the tribe gave $1.5 million to the University of Oklahoma College of Medicine in Tulsa for treatment and research of diabetes and cancer.

"I think the tribe has done a great job in demonstrating leadership through diabetes prevention

Dr. David Randall, chief of podiatry for the tribe, said he has seen the results of the diabetes program in fewer amputations and better access to foot care. Among the improvements in foot medicine are monthly shoe clinics and availability of high-quality, professionally fit shoes, regardless of ability to pay.

"It is far easier to prevent a problem than to salvage it (the foot) after a problem has come about,” he said.

Foot care is particularly important because nerve damage often causes diabetics to be unable to feel pain in their feet. A pebble in a shoe can lead to a hard-to-treat sore and, eventually, to amputation. Sufferers often don't notice they have sores.

The tribe has confronted diabetes "full force,” he added. Patients are more "proactive” and they no longer have a fatalistic attitude about the disease.

The tribe also focuses on places where changes can have a wide impact; in many rural areas, the school serves as the de-facto center of community life, so opening up gyms and walking tracks, serves children and adults.

Teachers may request state-recognized curriculum that promotes exercise using the Trail of Tears and Cherokee culture as teaching tools.

A more subtle approach is asking restaurants to place icons next to healthy menu items. One such place is the Iguana Cafee, a coffee shop that serves sandwiches a few hundred yards from Northeastern State University.

"I think people come in here because there's no deep-fried food. It's not fries, it's not burgers,” Iguana Owner Gordon Zabik said.

Lisa Pivec, director of community health promotion for the tribe, not