“Parent-Child Conflict, Autonomy and Diabetes Self-Care in Adolescents with Type 2 Diabetes”
(ancillary to TODAY study: Dr. Kenneth Copeland and Jeffrey Preske, M.A., University of Oklahoma Health Sciences Center)

In July 2007 this short ancillary project to the larger TODAY study (a project to evaluate treatment of type 2 diabetes in youth) was completed. The purpose of this study was to observe how parent-youth conflicts relate to the level of self-care and compliance to the treatment plan in youth ages 10-20 years with type 2 diabetes. Enrollment and data collection ended in September 2006. The Chickasaw Nation was one of seven national sites in this study; to date there are no results available to report. Of the 38 total participants fourteen were American Indian; of these four were Chickasaw. There were no adverse events reported and there have been no publications from this study.

“Implementing Best Practices - Program Evaluation and Program Development for an American Indian Gestational Diabetes Program”
(Steven D. Gomez, B.S., University of North Texas department of anthropology)

In May 2007 Mr. Gomez concluded a nine-month Masters thesis project evaluating the CNHS diabetes program for women with diabetes during pregnancy. Mr. Gomez’ project included interviews with the CNHS diabetes staff as well as face-to-face and phone interviews with current and past patients of the gestational diabetes program. These are his twelve recommendations based on his findings, which have already been presented to the CNHS diabetes program staff:

1. Conduct economic assessments including budget; develop individualized, practical economic plans; conduct grocery store tours.
2. Make current commodity grocery list available in the DCC.
3. Develop recipe book from staff and patients.
4. Compile list of trusted websites for diabetes information.
5. Develop a collective, consensual statement on the causes of all forms of diabetes.
6. Continuing education: monthly “journal club” presentations at monthly staff meeting.
7. Provide information and education for appropriate feeding practices beyond breastfeeding and strategies to continue healthy practices.
8. Develop a childhood diabetes prevention program.
9. Review current practice methods:
   • follow up appointments with DCC providers beyond initial consult.
   • provide a variety of education delivery methods.
   • develop basic “cheat sheet” with medical jargon, lab tests.
   • provide information on storage of insulin, especially when traveling.
10. Review individual daily food routines and develop practical strategies proper nutrition during pregnancy.
11. Develop a primary prevention awareness campaign addressing modifiable risk factors.
12. Expand the role of behavioral health provider and provide earlier intervention.

The CNHS diabetes program staff is evaluating these recommendations. In progress is the development of a treatment program for children at high risk for developing diabetes. Already in place is the Special Diabetes Prevention Program, a project to prevent the onset of type 2 diabetes in adults by increasing physical activity to 30 minutes five times a week, losing a moderate amount of weight and limiting the amount of fat eaten.