Diabetes is the sixth leading cause of death in the United States. Among diabetics heart disease is the primary cause of diabetes-related deaths and is 2-4 times higher in people with diabetes than those without the disease (ADA, 2002a; Centers for Disease Control, 2001). A life-threatening consequence of type 1 diabetes is diabetic coma due to ketoacidosis resulting from the exclusive use of fat as an energy source.
The most frequent complications of long-term diabetes occur because of abnormalities in the blood vessels and nerves caused by chronic hyperglycemia. Diabetes is the leading cause of blindness, kidney failure, and amputations of the lower limb. There are also abnormalities that occur in the immune, cardiovascular, and digestive systems as well as periodontal disease, sexual dysfunction, and complications of pregnancy (ADA, 2002a; Harris, 1995). Diabetes also is associated with psychological and social dysfunction. Because type 2 diabetes often does not have an acute onset, it may go undiagnosed for a number of years until a consequence of the disease is treated and the underlying diabetes is diagnosed (ADA, 2002a; Centers for Disease Control, 2001).
In the United States, Native Americans exhibit the highest mortality and complication rates of any ethnic groups. The Native American population's age-adjusted diabetes mortality rates for 1991-93 were 11.9/100,000 for the United States but 31.7/100,000 for all Indian Health Service areas (Gohdes & Acton, 2000). Native American diabetics are four times more likely than their white counterparts to experience a lower limb amputation and six times more likely experience end stage renal disease or kidney failure. In Oklahoma, a state with more than 30 tribes, 24% of Oklahoma Indians have diabetic retinopathy (ADA, 2002b).
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