In our recent article on diabetes trends in the U.S. (1), we reported that the prevalence of diagnosed diabetes in U.S. adults increased from 4.9% in 1990 to 6.5% in 1998. For this study, we classified participants into four race-ethnic groups: Caucasian, African-American, Hispanic, and other (1). The “other” category included Asian, Pacific Islander, American Indian (AI), Alaska Native (AN), and other race-ethnic groups specified by the respondents. This classification of “other” was necessary because of the small numbers of participants in each of these groups, thus making definitive conclusions in this category problematic. However, we are concerned that even these limited data seem to indicate a sharp increase in diabetes among these populations. In fact, we pointed out in our article that our reported rates of diabetes were very likely to be an underestimate of the true rates because we only included participants who had a telephone and had been diagnosed with diabetes.

To provide more detailed information on this important health issue, we conducted additional analyses using a separate category for AI/AN. Our sample included 697 (0.7%) and 1,159 (0.8%) AI/AN in 1990 and 1998, respectively. During that period, diabetes increased from 5.2 to 8.5% among AI/AN, a 63.5% increase in 8 years. These rates are likely an underestimate of the true rates among this ethnic group. Previous Centers for Disease Control and Prevention studies conducted among AI/AN reported a much higher rate of diabetes. Will et al. (2) reported an age-adjusted prevalence of 22.9% for diabetes among Navajo adults aged ≥20 years. In a recent study, Burrows et al. (3) reported that the age-adjusted rate of diagnosed diabetes among AI/AN increased from 6.2% in 1990 to 8.0% in 1997, a 29% increase. Clearly, this increase results in serious health challenges for AI/AN populations, as discussed in another recent publication (4).

In conclusion, diabetes is a critical public health problem among all people in the U.S., including AI/AN. To reduce the burden of diabetes among all groups, it is imperative to increase current efforts in diabetes prevention, quality diabetes care, and patient education. New initiatives may also be required, such as aggressive campaigns to decrease the likelihood of developing diabetes, especially among youth. The development of culturally sensitive programs to facilitate weight reduction among people with diabetes, using a balanced diet and increased physical activity, is also a high public health priority (5).

Mokdad AH, Ford ES, Bowman BA, Nelson DE, Engelgau MM, Vinicor F, Marks JS: Diabetes trends in the U.S.: 1990 to 1998.
Diabetes Care
Will J, Strauss K, Mendlein J, Ballew C. White LL, Peter DG: Diabetes mellitus among Navajo Indians: findings from the Navajo Health and Nutrition Survey.
J Nutr
127(Suppl. 10)
Burrows NR, Geiss LS, Engelgau MM, Acton KJ: Prevalence of diabetes among Native Americans and Alaska Natives, 1990–1997: an increasing burden.
Diabetes Care
End-stage renal disease attributed to diabetes among American Indians/Alaska Natives with diabetes: United States, 1990–
. Morb Mortal Wkly Rep
Clark C, Fradkin J, Hiss R, Lorenz R, Vinicor F, Warren-Boulton E: Promoting early diagnosis and treatment of type 2 diabetes: the National Diabetes Education Program.

Address correspondence and reprint requests to Ali H. Mokdad, PhD, CDC, 4770 Buford Highway, N.E., Mailstop E62, Atlanta, GA 30341-3717.