Abstract
Objective The Northern Plains Indians of the Cheyenne River Sioux Tribe have experienced significant lifestyle and dietary changes over the past seven generations that have resulted in increased rates of diabetes and obesity. The objective of this study was to determine if Northern Plains Indians with type 2 diabetes mellitus who are randomized to receive culturally adapted educational lessons based on the Medicine Wheel Model for Nutrition in addition to their usual dietary education will have better control of their type 2 diabetes than a nonintervention, usual care group who received only the usual dietary education from their personal providers. Design A 6-month, randomized, controlled trial was conducted January 2005 through December 2005, with participants randomized to the education intervention or usual care control group. The education group received six nutrition lessons based on the Medicine Wheel Model for Nutrition. The usual care group received the usual dietary education from their personal providers. Participants One hundred fourteen Northern Plains Indians from Cheyenne River Sioux Tribe aged 18 to 65 years, with type 2 diabetes. Methods Weight, body mass index (BMI), hemoglobin A1c, fasting serum glucose and lipid parameters, circulating insulin, and blood pressure were measured at the beginning and completion. Diet histories, physical activity, and dietary satiety surveys were measured at baseline and monthly through completion. Differences were determined using Student t tests, χ 2 tests, and analysis of variance. Results The education group had a significant weight loss (1.4±0.4 kg, P≤0.05) and decrease in BMI (1.0±0.1, P≤0.05) from baseline to completion. The usual care group had no change in weight (0.5±0.5 kg) or BMI (0.5±0.2). There were no between group differences due to intervention in energy, carbohydrate, protein, and fat intake and physical activity. Conclusions The culturally based nutrition intervention promoted small but positive changes in weight. Greater frequency and longer duration of educational support may be needed to influence blood glucose and lipid parameters.
Highlights
The Cheyenne River Sioux people have witnessed major dietary transitions over the past seven generations
A diet patterned after the historical hunter-gatherer type diet, or even the early reservation diet, may provide better blood glucose control and lower the circulating insulin levels in Northern Plains Indians with type 2 diabetes
The objective of this study was to determine if Northern Plains Indians with type 2 diabetes mellitus who are randomized to receive culturally adapted educational lessons based on the Medicine Wheel Model for Nutrition in addition to their usual dietary education will have better control of their type 2 diabetes than a non-intervention, usual care group who received only the usual dietary education from their personal providers
Summary
The Cheyenne River Sioux people have witnessed major dietary transitions over the past seven generations. The beginning of this transition occurred simultaneously with the rapid decline in the buffalo and the loss of much of their traditional hunting grounds. In the early years of the reservation until the 1950’s the Cheyenne River Sioux were involved in food production; gardening, hunting and gathering, which, combined with monthly government issued rations, provided most all the dietary components. A few traditional foods remain: traditional soups and stews some made with dried corn and dried buffalo (papa) and prairie turnip (tinpsila), tripe soup (taniga), stewed berries (wojapi), wild mint teas, wasna or pemmican, and kabubu bread – a skillet bread. True Indian food is a delicacy today.” [5]
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