At present, there are no specific dietary guidelines for the Northern Plains Indian with type 2 diabetes. Current medical nutrition therapy practices base the diabetic therapeutic guidelines on the Food Guide Pyramid that encourages a grain-based diet. Anecdotally, Northern Plains Indians have reported a better control of their type 2 diabetes when following a diet higher in protein. Genetic differences may contribute to decreased adaptation to higher carbohydrate loads among Northern Plains Indians compared to Northern European descendents. A diet patterned after the historical hunter-gatherer type diet, or even the early reservation diet (with higher proportion of energy being supplied from protein), may lower the circulating insulin levels and provide better blood glucose control in Northern Plains Indians with type 2 diabetes. The hypothesis of this application is that Northern Plains Indians with non-insulin dependent, type 2 diabetes who receive an educational lesson that promotes a diet patterned according to the traditional consumption of macronutrients (25% calories from protein, 45-50% from carbohydrate, and 25-30% from fat) will have a better control of their diabetes as measured by their HbA1C, blood glucose, and circulating insulin concentrations compared to those educated to consume a grain-based diet that supplies a more typical mix of macronutrients (10-15% calories from protein, 50-55% from carbohydrate, and 30-35% from fat). A 26- week, dietary educational intervention given monthly will be conducted in the Northern Plains Indians from the Cheyenne River Reservation (Lakota Sioux). Adult Lakota volunteers with type 2 diabetes will be recruited and randomized to an experimental (Medicine Wheel Model) or control (Usual Care) group. The experimental group will receive dietary training using the Medicine Wheel Model for Native Nutrition, which promotes a diet patterned according to the traditional consumption of macronutrients. The control group will receive the usual care dietary training based on the Food Guide Pyramid. Primary outcome variables of HbA1C, fasting blood glucose, and circulating insulin concentrations and secondary outcome variables of blood lipid concentrations will be measured at the beginning and end of trial. Measurements of potential confounders of weight, height, usual dietary intake, activity levels, medication use, and incidence of infection will be taken at the beginning and end of the study period.
| Kattelmann, Kendra K; Conti, Kibbe; Ren, Cuirong (2009) The medicine wheel nutrition intervention: a diabetes education study with the Cheyenne River Sioux Tribe. J Am Diet Assoc 109:1532-9 |
