Population Research and Policy Review 16: 169–192, 1997.
1997 Kluwer Academic Publishers. Printed in the Netherlands.
Diabetes mellitus in Native Americans:
The problem and its implications
K.M. VENKAT NARAYAN
National Institutes of Health, Phoenix, Arizona, USA
Abstract. Since World War II, diabetes has become one of the most common serious diseases
among Native Americans. Rates of diabetes and its complications, which include premature
death, renal failure, and limb amputation, are substantially higher among Native Americans
than among the US general population, and the frequency of diabetes among Native Americans
is increasing. Several potentially modiﬁable factors, including obesity, dietary composition,
and physical inactivity, are thought to be contributing to these high rates. The potential beneﬁt
from prevention of diabetes is considerable, and a population-based approach may be the most
effective way of achieving sustainable lifestyle changes among Native Americans. Estimation
of the social and economic costs of diabetes and assessment of the marginal costs and beneﬁts of
various diabetes control measures cansupport resource allocation decisions aimed at improving
the health of Native American people.
Key words: Diabetes mellitus, American Indians, Prevention, Gila River Indian Community
Diabetes mellitus is a group of metabolic disorders characterized by abnor-
mally high levels of blood glucose secondary to inefﬁcient insulin action
and/or secretion. The disease often leads to signiﬁcant disability, including
renal failure, blindness, and limb amputation, and to premature death.
Diabeteswas apparentlyrare among Native Americans until the middlepart
of the twentieth century (Joslin 1940; West 1974; Sievers & Fisher 1985).
However, since World War II, it has become one of the most common serious
diseases among many Native American tribes (Sievers & Fisher 1985); in
1987, there were at least 72,000 Native Americans in the USA with diagnosed
diabetes (Newman et al. 1990). Diabetes occurring in Native Americans is
almost exclusively the type referred to as NIDDM or non-insulin-dependent
diabetes mellitus (Sievers & Fisher 1985). The Pima Indians have the highest
recorded prevalence and incidence of NIDDM in the world (Knowler et al.
1978; King & Rewers 1991). High rates have also been observed among
other Native American tribes (Sievers & Fisher 1985; Gohdes 1986; Young
& Shah 1987), as well as in many diverse societies worldwide that have