The medicine wheel nutrition intervention: a diabetes education study with the Cheyenne River Sioux Tribe.
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.


METHODS
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.


METHODS
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, chi(2) tests, and analysis of variance.


RESULTS
The education group had a significant weight loss (1.4+/-0.4 kg, P<or=0.05) and decrease in BMI (1.0+/-0.1, P<or=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.
Kattelmann
Kendra K
KK
Nutrition, Food Science and Hospitality Department, South Dakota State University, Brookings, SD 57007, USA. Kendra.kattelmann@sdstate.edu
Conti
Kibbe
K
Ren
Cuirong
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000208:ethnology / Q000517:prevention & control*; D004032:Diet / Q000208:ethnology*; D005260:Female; D006266:Health Education / Q000379:methods*; D006801:Humans; D007198:Indians, North American; D008019:Life Style; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D018673:Nutrition Policy; D052756:Nutritional Sciences / Q000193:education*; D009765:Obesity / Q000097:blood / Q000208:ethnology / Q000517:prevention & control*; D010349:Patient Compliance; D015431:Weight Loss / Q000502:physiology; D014959:Wyoming; D055815:Young Adult
D001786:Blood Glucose; D008055:Lipids
Diabetes Care. 2001 May;24(5):811-6
11347735
J Transcult Nurs. 2006 Jul;17(3):234-45
16757662
Am J Public Health. 2002 Sep;92(9):1485-90
12197981
Am J Public Health. 2005 Sep;95(9):1518-22
16051933
Diabetes Care. 2006 Aug;29(8):1866-71
16873794
J Am Diet Assoc. 2005 Dec;105(12):1895-903
16321595
J Am Diet Assoc. 1999 Jul;99(7):829-35
10405681
Prev Med. 2003 Dec;37(6 Pt 2):S107-12
14636815
N Engl J Med. 2002 Feb 7;346(6):393-403
11832527
Eur J Clin Nutr. 1995 Sep;49(9):675-90
7498104
Diabetes Care. 1999 Apr;22(4):623-34
10189543
J Transcult Nurs. 2002 Jan;13(1):6-11
11776018
Lancet. 1995 Oct 21;346(8982):1080-4
7564792
Am J Clin Nutr. 1990 Mar;51(3):416-20
2178389
Adv Data. 2003 Apr 17;(334):1-4
12743879
J Womens Health Gend Based Med. 1999 Jul-Aug;8(6):805-13
10495261
Am J Clin Nutr. 1990 Feb;51(2):241-7
2305711
Med Anthropol. 1989 Jun;11(3):329-50
2671575
Diabetes Care. 2002 Jan;25(1):78-83
11772905
Annu Rev Nutr. 1999;19:17-40
10448515
J Clin Epidemiol. 1999 Mar;52(3):219-27
10210239