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PurposeThe purpose of this study was to evaluate the feasibility of translating the Diabetes Prevention Program (DPP) lifestyle intervention into practice in the general community.MethodsIn 2008, the Montana Diabetes Control Program, working collaboratively with 4 health care facilities, implemented an adapted group-based DPP lifestyle intervention. Adults at high risk for diabetes and cardiovascular disease were recruited and enrolled (n = 355). Eighty-three percent (n = 295) of participants completed the 16-session program. Participants set targets to reduce fat intake and increase physical activity (>/=150 minutes per week) to achieve a weight loss goal of 7%.ResultsSeventy percent of participants achieved the physical activity goal of >/= 150 minutes per week. There was a significant decrease among participants' weight from baseline (mean ± SD, 99.3 ± 19.7 kg) to week 16 (92.6 ± 18.8 kg; mean difference, 6.7 ± 4.0 kg, P < .001). Forty-five percent of the participants achieved the 7% weight loss goal, and 67% achieved at least 5% weight loss. Participants who were 60 years of age and older, had a diagnosis of hypertension, met their physical activity goal of >/=150 minutes per week, and those more frequently monitoring their fat intake were more likely to meet the 7% weight loss goal compared with participants without these characteristics.ConclusionThe findings suggest that it is feasible to recruit and retain high-risk participants and achieve weight loss and physical goals in a group setting that are comparable with those achieved in the DPP. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the utilization of a tobacco quit line prior to and after an increase in tobacco taxes. METHODS: Intake data were utilized to assess the number of callers to the quit line between May 2004 and April 2006. The characteristics of callers were also compared over three time periods; the 5 months prior to a voter initiative to increase the tax (May-September 2004), the 3 months just prior to the tax increase (October-December 2004), and the 5 months after the tax became effective (January-May 2005). RESULTS: The mean number of intake calls to the quit line between May 2004 and April 2006 was 388 per month (range = 200-1 088). The number of calls per month increased just prior to and just after the tax increase (3-month moving average = 691-731 calls). Persons completing an intake between October to December 2004 and January to May 2005 were more likely to be younger than 45 years, woman, White, smoke one or more packs of cigarettes per day, and were less likely to have tried to quit using tobacco in the past year than did persons calling between May and September 2004. CONCLUSIONS: Organizations supporting quit lines should anticipate an increase in the utilization of these services and changes in the characteristics of callers prior to and following an increase in tobacco taxes. [ABSTRACT FROM AUTHOR]

PURPOSE: Diabetes self-management education (DSME) is an integral component of diabetes care; however, skilled educators and recognized programs are not uniformly available in rural communities. METHODS: To increase access to quality DSME, the Montana Diabetes Control Program and the Montana chapter of the American Association of Diabetes Educators developed a mentoring program with 3 levels: basic, intermediate, and advanced. All participants were assisted by a volunteer certified diabetes educator (CDE) mentor. In addition, the program provided technical support for recognition through the American Diabetes Association and the Indian Health Service. RESULTS: From 2000 to 2005, 90 individuals participated; 76% were nurses and 21% dietitians. Twenty-seven of the 90 enrollees (30%) completed their structured option, and 13 achieved CDE certification. Most provided services in frontier counties (66%). Statewide, the number of CDEs in Montana increased 46% from 52 in 2000 to 76 in 2005. Twenty-five of the 30 facilities that received technical assistance achieved recognition. Statewide, the number of recognized education programs increasedfrom 2 in 2000 to 22 in 2005. Twelve (55%) of these programs were located in frontier counties. CONCLUSIONS: Mentoring and technical support is an effective method to increase personnel skills for DSME and to increase access to quality education programs in rural areas. [ABSTRACT FROM AUTHOR]

PURPOSE: This article describes a pilot project to improve knowledge, attitudes, and skills of ad hoc interpreters working with Native American diabetes patients with limited English proficiency. METHODS: Case-based studies reflecting clinical situations were developed. Key concepts and terms from the cases were translated into the Navajo language and carefully back translated using the newly standardized Navajo diabetes terminology. Twenty-two health care workers from 2 Indian Health Service facilities were recruited for a pilot study to compare the performance of interpreters trained in a formal workshop using the case studies with that of interpreters who independently reviewed a video made from the training. RESULTS: Workshop participants noted significant improvements in their knowledge and comfort level in interpretation of diabetes concepts but not about unrelated topics; the independent study group perceived less improvement. CONCLUSION: Formal training for interpreters working with diabetes patients should be considered by diabetes educators working in settings where medical interpreters are needed. Diabetes educators should encourage back translation of key diabetes concepts to understand exactly what is being said to patients. Those working with multiple interpreters should make sure there are opportunities for interpreters to discuss translations of key concepts with each other and the educators so that translations are accurate and consistent among interpreters. Independent study did not appear to be an effective way to improve the ability of interpreters to translate current diabetes concepts accurately. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To assess trends in diabetes screening among American Indian adults and identify opportunities to extend blood glucose screening to those at risk for undiagnosed diabetes and prediabetes. METHODS: In 1999, 2001, and 2003, approximately 1,000 American Indian adults aged 18 years and older living on or near the seven reservations in Montana were interviewed through telephone surveys. RESULTS: Of respondents without diagnosed diabetes, the proportion who recalled blood glucose screening for diabetes within the past 3 years increased from 68 percent in 1999 to 78 percent in 2003. Between 1999 and 2003, screening increased among men (64%-75%), women (71%-80%), those aged 18-44 years (64%-72%), and those aged 45 years and older (76%-84%). Factors independently associated with screening included age more than 45 years, family history of diabetes, and a history of high cholesterol. Current smokers were less likely to report screening compared to nonsmokers. Gender, obesity, and a history of high blood pressure were not associated with screening. CONCLUSIONS: Although self-reported diabetes screening increased over a 5-year period among Indians in Montana, additional groups who could benefit from screening include younger and obese individuals, and those with hypertension. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The purpose of this study was to assess trends in diabetes in pregnancy in American Indian and whites mothers in Montana and North Dakota. METHODS: Montana and North Dakota birth records were utilized to assess trends in any diabetes in pregnancy in American Indians and whites from 1989 to 2000. RESULTS: From 1989 through 2000, there were 133,991 and 102,232 births in Montana and North Dakota, respectively. The majority of mothers were American Indian (11%) or white (87%). The rate of any diabetes in pregnancy increased significantly in Montana Indian (3.1-4.1%, p = 0.04) and white mothers (1.8-2.6%, p < 0.001) from 1989-1991 to 1998-2000. The rate also increased significantly in white North Dakota mothers (1.6-3.2%, p < 0.001), but the increase in rate for Indian mothers in North Dakota did not reach statistical significance (3.8-4.8%, p = 0.06) during this time period. In each time period, Montana and North Dakota Indian mothers were more likely than white mothers to have any diabetes in pregnancy. CONCLUSIONS: The rate of diabetes in pregnancy has increased in American Indian and white mothers. Thus public health programs are now facing an increasing number of women with a history of GDM at future risk of type 2 diabetes and an increasing number of offspring of diabetic pregnancies at risk for becoming overweight and developing type 2 diabetes at a young age. [ABSTRACT FROM AUTHOR]

Diabetes care among medically underserved patients is suboptimal. Few studies, however, have described successful strategies to improve diabetes care in these patient populations. To address this issue, 4 Montana community health centers and 1 urban Indian health center implemented quality improvement efforts along with an office-based electronic system for monitoring diabetes care. After a median of 17 months follow-up, preventive services and clinical outcomes were assessed for all patients at baseline (N = 332) and follow-up (N = 590), and for a cohort (N = 164) who had 1 or more visits 6 months after baseline. In cross-sectional analyses, there were increases from baseline to follow-up in the percent of patients who had received an annual foot examination (50% to 68%), microalbuminuria testing (34% to 62%), annual retinal examination (14% to 30%), pneumococcal immunization (30% to 61%), and smoking assessment (77% to 91%). But neither HbA1c testing in the previous 6 months (64% to 55%) nor annual LDL-C testing (59% to 61%) showed any improvement. There were no significant changes from baseline to follow-up in the median hemoglobin A1c (HbAlc), low density lipoprotein-cholesterol (LOL-C), or in systolic and diastolic blood pressure values. Similar improvements in preventive care were seen in the cohort of patients with diabetes. But overall outcomes were not improved. Our findings suggest that office-based monitoring systems can support systems' changes to improve the delivery of preventive services to patients with diabetes in primary care facilities for the underserved, but outcomes are more difficult to enhance over a short period of follow-up. Also, our findings suggest that over a relatively short-term period, cross-sectional and cohort analyses of quality improvement measures do yield similar measures of diabetes care in such settings. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The purpose of this study was to compare the prevalence of cigarette smoking and smoking cessation among American Indians living on or near Montana's seven reservations to those of non-Indians living in the same geographic region. METHODS: Data for Montana Behavioral Risk Factor Surveillance System (BRFSS) respondents (n = 1,722) were compared to data from a BRFSS survey of American Indians living on or near Montana's seven reservations in 1999 (n = 1,000). Respondents were asked about smoking and smoking cessation as well as cardiovascular disease (CVD) and selected risk factors. Quit ratios were calculated for both groups. RESULTS: American Indians were more likely to report current smoking (38%) than non-Indians (19%; p < 0.001). Thirty-seven percent of Indian respondents with CVD risk factors reported current smoking, compared with 17% of non- Indians with CVD risk factors. However, there was no significant difference in reported smoking rates between Indians (21%) and non-Indians (27%) with a history of CVD. Indian smokers were more likely to report quitting for one or more days in the past year (67%), compared with non-Indians (43%). Quit ratios were significantly lower among Indians (43%) than among non-Indians (65%). CONCLUSIONS: High smoking rates in Indians, particularly among those with other CVD risk factors, demonstrate an urgent need for culturally sensitive smoking cessation interventions among Northern Plains Indians and highlight the need for the Surgeon General's focus on smoking in minority populations. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The purpose of this study was to describe the consistency of coding of American Indians on Montana death certificates and to identify the characteristics of American Indians in Montana associated with consistent classification on death certificates. METHODS: The Billings Area Indian Health Service (IHS) patient registration file was linked with Montana Department of Health and Human Services death certificate files for 1996-1998. RESULTS: A total of 769 Montana residents who had died in 1996-1998 were matched to the IHS registration file. Of these decedents, 696 (91%) were consistently classified as American Indian on the death certificate. Seventy-two (99%) of the 73 decedents not classified as Indian were classified as white. American Indians living in counties on or near the seven Montana reservations were more likely to be consistently classified than Indians living in other counties (95% vs. 70%); those with less than 12 years of education (93% vs. 88%) were more likely to be consistently classified than those with 12 or more years of education. Decedents whose cause of death was suicide were less likely than those with other causes of death to be consistently classified (72% vs. 95%). In contrast, a higher percentage of those with an alcohol-related cause of death than of those with other causes of death were consistently classified, although this difference was not statistically significant. CONCLUSIONS: The mortality rates for Montana American Indians are underestimated overall, and are differentially under- and overestimated for selected conditions. [ABSTRACT FROM AUTHOR]

PURPOSE: The objective of this study was to compare self-reported knowledge about A1C testing with information from the medical record. METHODS: A telephone survey was conducted among patients with diabetes in a rural fee-for-service practice and a community health center. Self-reported information regarding A1C testing, the last A1C value, and perceived blood glucose control was compared with the most current A1C value documented in the medical record. RESULTS: Seventy five percent of survey respondents reported having 1 or more A1C tests in the past year, which generally agreed with information from their medical records. However, only 24% of those who reported having a test remembered the actual value, and the self-reported values correlated weakly with the last A1C on the medical record. Among those with a documented A1C value, half described their blood glucose as very well controlled. The last A1C value, however, was < 7.0% in only half of those respondents. CONCLUSIONS: Persons with diabetes were aware of their previous A1C testing but did not interpret the values accurately in relation to their own glycemic control. If clinicians expect patient knowledge and understanding of glycemic control measures to improve outcomes of care, patient education will need to emphasize the meaning of these values. [ABSTRACT FROM AUTHOR]

In many American Indian communities, the rate of diabetes has increased dramatically over the past 20 years. This health problem has become a major challenge for the Indian Health Service (IHS). The Diabetes Education Program of the IHS wanted to use the National Standards to promote the best quality diabetes education programs in all IHS and tribal facilities. However, the review criteria for the National Standards had to be adapted to fit the unique needs of the Indian communities. This paper describes the process used to evaluate and modify the review criteria to implement the National Standards within IHS health care facilities. [ABSTRACT FROM AUTHOR]