Diabetes prevention in American Indians and Alaska Natives: where are we in 1994?

American Indians and Alaska Natives have experienced rapidly increasing rates of non-insulin-dependent diabetes (NIDDM). To address this epidemic Indian Health Service (IHS) and tribal communities have developed primary, second and tertiary intervention strategies. The scientific basis for secondary and tertiary prevention supports well-defined care practices, and the surveillance of the implementation of these practices and their impact on metabolic and hypertension control is now standard. Community interventions for the primary prevention of diabetes are underway and reflect the priorities of individual communities.