title: Cardiometabolic correlates of low type 2 diabetes incidence in western Alaska Native people - The WATCH study.
abstract: OBJECTIVE
  Previously rare among Alaska Native (AN) people, type 2 diabetes (DM2) prevalence as indicated by registry data has increased by as much as 300% in some western Alaska regions. We sought to determine prevalence and incidence of DM2 and analyze associated cardiometabolic risk factors in western AN people.
  
  
  METHODS
  DM2 and prediabetes prevalence and incidence were determined by the Western Alaska Tribal Collaborative for Health using consolidated data from cohort studies conducted during 2000-2010. Crude and age-adjusted incidence for DM2 and prediabetes were calculated using 2010 American Diabetes Association criteria. Effects of covariates on DM2 and prediabetes were determined using univariate and multivariate Cox proportional hazards analyses, adjusted for age and sex.
  
  
  RESULTS
  Excluding baseline diabetes (n=124, 4.5%), 53 cases of new DM2 were identified among 2630 participants. Age- and sex-adjusted DM2 incidence was 4.3/1000 (95% CI 2.9, 5.0) person-years over an average 5.9-year follow up. After excluding baseline prediabetes, 387 new cases of prediabetes were identified among 1841 participants; adjusted prediabetes incidence was 44.5/1000 (95% CI 39.5, 49.5) person years. Independent predictors for DM2 included age, impaired fasting glucose, and metabolic syndrome; family history of diabetes and obesity were additional independent predictors for prediabetes.
  
  
  CONCLUSIONS
  DM2 incidence in western AN people is substantially lower than that for U.S. whites; however, incidence of prediabetes is more than 10-fold higher than western AN DM2 incidence and more closely aligned with U.S. rates. Interventions aimed at achieving healthy lifestyles are needed to minimize risk factors and maximize protective factors for DM2 in this population.
authors: Alaska Native Tribal Health Consortium, Division of Community Health Services, Anchorage, AK, United States. Electronic address: kkoller@anthc.org.
authors: Kathryn R
authors: KR
authors: Koller
authors: University of Alaska Anchorage, Anchorage, AK, United States.
authors: Jesse S
authors: JS
authors: Metzger
authors: Cleveland Clinic Medicine Institute, Cleveland, OH, United States.
authors: Stacey E
authors: SE
authors: Jolly
authors: MedStar Health Research Institute, Hyattsville, MD, United States; Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC, United States.
authors: Jason G
authors: JG
authors: Umans
authors: University of Alaska Fairbanks, Center for Alaska Native Health Research, Fairbanks, AK, United States.
authors: Scarlett E
authors: SE
authors: Hopkins
authors: University of Alaska Fairbanks, Center for Alaska Native Health Research, Fairbanks, AK, United States.
authors: Cristiane
authors: C
authors: Kaufmann
authors: Alaska Native Tribal Health Consortium, Division of Community Health Services, Anchorage, AK, United States.
authors: Amy S
authors: AS
authors: Wilson
authors: Norton Sound Health Corporation, Nome, AK, United States.
authors: Sven O E
authors: SO
authors: Ebbesson
authors: Alaska Native Tribal Health Consortium, Division of Community Health Services, Anchorage, AK, United States.
authors: Terry W
authors: TW
authors: Raymer
authors: University of Washington, Seattle, WA, United States.
authors: Melissa A
authors: MA
authors: Austin
authors: MedStar Health Research Institute, Hyattsville, MD, United States; Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC, United States.
authors: Barbara V
authors: BV
authors: Howard
authors: University of Alaska Fairbanks, Center for Alaska Native Health Research, Fairbanks, AK, United States.
authors: Bert B
authors: BB
authors: Boyer
mesh_terms: D000328:Adult; D000413:Alaska / Q000453:epidemiology; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology*; D005260:Female; D006801:Humans; D015994:Incidence; D007198:Indians, North American / Q000208:ethnology*; D008297:Male; D024821:Metabolic Syndrome / Q000208:ethnology*; D011236:Prediabetic State / Q000150:complications / Q000208:ethnology*; D015995:Prevalence; D012307:Risk Factors
keywords: Alaska Native (AN); DM2; Metabolic syndrome; Prediabetes; Risk factors; Western Alaska Tribal Collaborative for Health