Cooperative Agreement H1D1IHS1156

SAN CARLOS APACHE HEALTHCARE CORPORATION DIABETES TREATMENT AND PREVENTION PROGRAM - THE SAN CARLOS APACHE INDIAN RESERVATION IS A 1.8-MILLION-ACRE LAND BASE OF THE FEDERALLY RECOGNIZED SAN CARLOS APACHE TRIBE LOCATED IN SOUTHEASTERN ARIZONA. WE ARE A RURAL ARIZONA TRIBE, LOCATED 90 MILES EAST OF THE METROPOLITAN PHOENIX AREA. THE SAN CARLOS APACHE TRIBE HAS APPROXIMATELY 17,050 ENROLLED MEMBERS. IN ADDITION TO TYPE 2 DIABETES, THERE ARE OTHER DIABETES-RELATED COMORBIDITIES THAT ARE PREVALENT AMONG THE SAN CARLOS APACHE TRIBE SUCH AS OBESITY, CARDIOVASCULAR AND KIDNEY DISEASE. THE SAN CARLOS APACHE HEALTHCARE CORPORATION ("SCAHC") IS A SUBSIDIARY NONPROFIT HEALTHCARE ENTERPRISE OF THE SAN CARLOS APACHE TRIBE ESTABLISHED FOR THE PURPOSE OF PROVIDING DIRECT HOSPITAL AND CLINICAL SERVICES. SCAHC HAS BEEN WORKING ON BUILDING A COMPREHENSIVE DIABETES TREATMENT PROGRAM SPECIFIC TO THE SAN CARLOS APACHE TRIBE ALONGSIDE THE COMMUNITY DRIVEN DIABETES PREVENTION EFFORTS. CONTINUOUS EFFORTS BY SDPI COUPLED WITH SCAHC FUNDS WILL BE A SIGNIFICANT STEP IN ADDRESSING DIABETES AND ITS COMORBIDITIES ON THE SAN CARLOS APACHE RESERVATION. THE SAN CARLOS APACHE TRIBE HAS IDENTIFIED AN INCREASE IN DISEASE BURDEN SINCE THE BEGINNING OF THE CURRENT GRANT CYCLE FY2016-FY2022. IN 2015, 1392 INDIVIDUALS WITH DIABETES WERE RECEIVING THEIR CARE IN SAN CARLOS. IN MARCH 2020 PRIOR TO THE PANDEMIC, WE IDENTIFIED 1743 INDIVIDUALS WITH DIABETES. DURING THE PANDEMIC, AS MORE INDIVIDUALS BEGAN COMING IN TO SCAHC FOR ACUTE ILLNESS INCLUDING COVID INFECTIONS, THE HOSPITAL BEGAN TO IDENTIFY UNDIAGNOSED INDIVIDUALS WITH UNCONTROLLED DIABETES. AS OF THIS YEAR, WE NOW HAVE OVER 1900 COMMUNITY MEMBERS WITH DIABETES THAT ARE ACTIVELY RECEIVING THEIR CARE AT SCAHC AND AN ADDITIONAL 675 INDIVIDUALS THAT ARE DIAGNOSED WITH DIABETES THAT ARE NOT ACTIVELY RECEIVING THEIR CARE AT SCAHC. IN OUR EFFORTS TO IDENTIFY PREDIABETES AND DIABETES, SCAHC HAS TAKEN THE INITIATIVE OF COMPLETING GLUCOSE CHECKS WHEN PATIENTS ARRIVE FOR ANY APPOINTMENT. SCAHC HAS ALSO ADDED A MOBILE HEALTH UNIT TO ASSIST IN PROVIDING HEALTHCARE WITHIN THE COMMUNITY TO INDIVIDUALS THAT MAY NOT HAVE OTHERWISE RECEIVED HEALTHCARE. WITH THE ADDITION OF THIS MOBILE HEALTH UNIT, OUR HOPE IS THAT WE CAN BUILD TRUST WITHIN THE COMMUNITY, PROVIDE HEALTHCARE AND EDUCATION TO PREVENT THE ONSET OF DIABETES AND MANAGE DIABETES TO DECREASE THE RISK OF DIABETES-RELATED COMORBIDITIES. WITHIN OUR SDPI CLINIC, WE CONTINUE TO PROVIDE DIABETES EDUCATION AND MEDICAL NUTRITION THERAPY AS WELL AS COMPREHENSIVE DIABETES CARE BY NURSE PRACTITIONERS, ENDOCRINOLOGISTS, A PODIATRIST, OPTOMETRISTS, DENTISTS, AND OUR PRIMARY CARE TEAM. THROUGH THIS COMPREHENSIVE CARE APPROACH OUR GOAL IS TO BUILD LONG LASTING TRUST WITH THE COMMUNITY MEMBERS AND IN RETURN IMPROVE GLYCEMIC CONTROL AND DECREASE RISK OF DIABETES AND ALL ITS COMORBIDITIES. AS OF SEPTEMBER 2021, WE HAVE ALSO BUILT A 3-TIER COMPREHENSIVE WEIGHT LOSS PROGRAM INCLUDING TIER 1 WITH NUTRITION AND LIFESTYLE MODIFICATIONS ONLY, TIER 2 ADDING MEDICATION ASSISTED WEIGHT LOSS AND TIER 3 COMPLETING BARIATRIC SURGERY WHEN TIER 1 AND 2 HAVE FAILED. SINCE THEN, WE HAVE ~80 INDIVIDUALS THAT ARE UTILIZING OUR MEDICATION ASSISTED WEIGHT LOSS AND 21 INDIVIDUALS THAT HAVE UNDERGONE BARIATRIC/METABOLIC SURGERY. MANY INDIVIDUALS HAVE BEEN ABLE TO REDUCE OR COMPLETELY STOP THEIR CHRONIC MEDICATIONS. SAN CARLOS HAS ALSO IDENTIFIED ~2225 INDIVIDUALS WITHIN THE COMMUNITY THAT HAVE PREDIABETES WHO WILL HAVE THE POSSIBILITY OF IMPROVING THEIR HEALTH THROUGH LIFESTYLE MODIFICATIONS AND DECREASING THEIR WEIGHT THROUGH COMMUNITY OUTREACH, THE DIABETES PREVENTION PROGRAM, AND EARLY INTERVENTION OF DIETITIAN SUPPORT. THE SDPI GRANT WOULD CONTINUE TO ASSIST IN GROWING OUR CURRENT AND NEW PROGRAMS. ADDITIONAL FUNDING TO BE CONSIDERED WOULD ALSO ASSIST IN OUR COMMUNITY OUTREACH EFFORTS THROUGH IMPROVEMENTS TO OUR FITNESS CENTERS INCLUDING GROUP FITNESS ROOMS AND CLASSROOMS TO PROVIDE A COMMU