Holistic Diabetes Program (health)

Holistic Diabetes Program for American Indians a Success


Apr 25, 2010 Juan Ramos

A diabetes program for American Indians encompassing four dimensions of holistic health-body, spirit, mind and emotion-is effective and culturally relevant.

The Full Circle Diabetes Program in Minneapolis, Minnesota, which used a holistic approach to diabetes self-management among American Indians, proved to be an effective, culturally relevant strategy to increase knowledge of resources for managing diabetes. A community case study on the program was published in the journal Preventing Chronic Disease (www.cdc.gov/pcd/issues/2009/oct/08_0147.htm)

Between 2004 and 2007, the program engaged 255 American Indian adults with type 2 diabetes from the Minneapolis/St. Paul area in activities encompassing four dimensions—body, spirit, mind and emotion. Two-thirds of participants reported that information they learned in the program helped them manage their diabetes. Almost all (98 percent) of program enrollees participated in at least one dimension activity, and two-thirds participated in two or more activities from more than one dimension. Diabetes breakfasts and nutritional consultations were the most popular activities.

Development of the Diabetes Program for American Indians

The Full Circle Diabetes Program was developed through a partnership between the Minneapolis American Indian Center (MAIC), the Native American Community Clinic (NACC) and Wilder Research. The partnership recruited community members to form a Diabetes Community Council. The Council comprised American Indian community members and elders from the Minneapolis/Saint Paul area, many of whom had type 2 diabetes. The Council represented the community and advised the partnership on program planning, development and evaluation.

Council members identified barriers to self-management by sharing personal stories. Barriers included infrequent blood sugar testing, poor eating habits, poor physical activity habits, difficulty coping with diabetes-related stress and lack of knowledge of self-management resources. The Council called their holistic approach to program development a "circle model" because of its close relationship to American Indian culture and values. Circles are ancient symbols of infinity, unity and wholeness. The circle model recognizes that all people contribute uniquely to the survival and vitality of a community.

The Four Dimensions of Holistic Health

Activities and services of the Full Circle Diabetes Program addressed four dimensions of holistic health: body, spirit, mind and emotion. Program activities were developed for each dimension with a focus on community needs.

Body dimension: Participants received routine physical exams and dietary advice. A diabetes case manager assessed patients' needs, assisted with referrals to low-cost or free health care services, and provided follow-up and support. The program offered exercise classes such as water aerobics, walking, stretching and light weight lifting; free gym memberships, physical therapy services, walking groups and consultations for home exercise programs; and nutritional consultations to develop healthier meal plans.

Spirit dimension: Clinicians supported traditional healers in providing alternative health care for participants who were interested in or already receiving treatment from healers. Diabetes Community Council meetings encouraged participants to share personal testimonies, which helped them feel less alone in their challenges and motivated them to make healthful life changes. Diabetes health fairs invited everyone in the community to participate and helped bring all generations together to learn, have fun and celebrate culture. Caregiver ceremonies acknowledged family, friends and health professionals for supporting diabetes health.

Mind dimension: Education classes focused on six topic areas—introduction to diabetes, nutrition, managing diabetes, lifetime health, physical activity and stress management. Monthly diabetes breakfasts gave participants the opportunity to share a healthy meal and benefit from ongoing diabetes education.

Emotion dimension: Talking circles provided a safe place for people to ask for and receive support from their peers and to know that others shared their challenges. Lists of mental health resources were available at each talking circle, and a mental health counselor was available. Self-esteem was nurtured by engaging participants in planned outreach activities, such as presentations at local schools. As they gained skills and had positive experiences planning and executing these activities, participants developed the confidence necessary to become advocates for self-management.

Continuation of Diabetes Self-Management Activities

Although the program ended in 2007, many of the activities have continued. The Diabetes Community Council changed its name to Community Health Council and has expanded its reach to include all health issues. Case management and nutrition counseling at NACC continues to provide guidance and support to diabetes patients to improve their self-management.

More information, including a resource toolkit for developing a comprehensive diabetes self-management program for urban American Indians, is available from DiabetesInitiative.org.


Castro S, O'Toole M, Brownson C, et al. A diabetes self-management program designed for urban American Indians. Prev Chronic Dis 2009; 6(4): A131.