Adults in Native American and Alaska Native communities are nearly three times more likely to develop type 2 diabetes than non-Hispanic white people in the U.S. However, this hasn’t always been the case. Between 1994 and 2004, diabetes rates doubled in these communities, especially among adults age 35 and younger.

Diabetes rates are especially high in Native American and Alaska Native communities. However, because of past unethical research practices, there’s limited research on the reason for this sharp rise. Genetics alone doesn’t explain the difference. These communities face higher diabetes risk due to environmental factors that affect them more often and more severely than other groups. Read on to learn more about these factors.

The Scope of the Diabetes Challenge

For centuries, diabetes was rare among Native American and Alaska Native people. By the 1980s, the condition was affecting these communities more often.

Today, diabetes is one of the most common diseases affecting Native American people, including youth. On average, people in these communities also have poorer health outcomes. Diabetes-related deaths among Native American people are nearly twice as high as in the overall U.S. population.

Why Diabetes Affects Native American Communities at High Rates

Environmental factors likely play a larger role than genetics in the high diabetes rates in Native American and Alaska Native communities. Researchers have several theories about the reasons.

Historical Trauma and Chronic Stress

The Indian Removal Act was passed by the U.S. Congress in 1830, forcing thousands of Native Americans to move to reservations or attend boarding schools. These changes led to major shifts in daily life. Native communities lost millions of acres of land and large buffalo herds, which had been central to their food systems and culture. This loss of resources led to collective trauma that continues to affect many communities today.

This is a form of generational trauma — severe stress that’s passed down through families. Chronic diseases, including diabetes, may be a possible effect. Trauma can even affect how genes work without changing the genes themselves. This process is known as epigenetics.

Chronic stress — whether from generational trauma or current challenges — is a known diabetes risk factor. Ongoing stress can change hormone levels and increase inflammation in the body. Over time, these changes can affect metabolism and lead to insulin resistance. When this happens, it’s harder for the body to control blood glucose levels.

Poverty and Limited Healthcare Access

Poverty is a risk factor for type 2 diabetes in Native American and Alaska Native communities. These populations have some of the highest poverty rates in the U.S. Many people are underinsured or don’t have health insurance. These barriers can make it harder to prevent, diagnose, or manage chronic diseases such as diabetes.

Limited Food Access and Dietary Factors

Moving to reservations changed the way many Native American communities accessed and prepared food. Traditional diets often included a variety of fruits, root vegetables, wild game, fish, and nuts. Meals were community-based, and food resources were shared.

Today, eating patterns in many communities look different. Like many U.S. groups, Native American and Alaska Native people may rely more on processed foods, which are often high in sodium, added sugars, and unhealthy fats. These foods are also lower in vitamins, minerals, and fiber — nutrients that are often plentiful in whole, minimally processed foods.

Limited access to healthy foods helps explain these major diet changes. Grocery stores may be located far from reservations. Limited finances and lack of transportation can make it hard to access nutrient-rich foods. Convenience stores on or near reservations often stock many processed foods such as chips, sodas, and candy bars. Some government-provided foods have also been high in fat and sugar while low in fiber.

Over time, eating patterns shaped by limited food access can contribute to high rates of obesity and type 2 diabetes. Research suggests that added sugars and sugar-sweetened beverages may play a major role in higher diabetes rates among Native American people.

Physical Activity Changes

In the past, daily life in many Native American communities involved high levels of physical activity, burning an estimated 4,000 calories a day. Activities such as farming, fishing, canoeing, and dancing required significant energy and movement.

Relocation to reservations and cities changed many of these routines. As physical activity levels declined, rates of obesity — a major risk factor for type 2 diabetes — increased.

How Diabetes Affects Native American Life

Beliefs about diabetes differ among Native American communities. For example, some Dakota communities link diabetes to the loss of traditional foods and cultural practices. Some Navajo communities may attribute diabetes to spiritual, emotional, or community imbalances.

A group’s belief system can shape how people understand diabetes and whether they seek treatment. People who identify closely with their Native American culture may choose traditional healing practices. Others may combine traditional and Western medicine.

Diabetes Complications

According to the Indian Health Service (IHS), Native Americans and Alaska Natives face a higher risk of diabetes complications, which are also more likely to develop at a younger age. Diabetes complications may include:

• Cardiovascular disease — Native Americans have historically had lower rates than some other racial and ethnic groups, but rising rates of diabetes and obesity are quickly narrowing the gap.
• Kidney problems — Diabetes raises the risk of chronic kidney disease and kidney failure. These conditions are often linked to diabetic nephropathy, which is kidney damage caused by long-term high blood sugar.
• Vision problems — Diabetes can cause eye problems such as diabetic retinopathy and glaucoma. Native American and Alaska Native people with diabetes are 27 percent more likely to get yearly eye exams, which can help find these problems early.
• Lower-extremity amputation — Foot and leg amputations occur more often among Native American and Alaska Native people with diabetes than in many other groups.

Burden on Families

Type 2 diabetes has a genetic component, meaning it can run in families. This is especially true when diabetes occurs at a younger age. Families affected by diabetes may face added financial stress due to the condition and its complications.

People who have strong family and social support are more likely to manage their diabetes consistently and maintain better glucose control.

Burden on Tribal Health Systems

About 1 in 6 Native American and Alaska Native adults have been diagnosed with diabetes. For that reason, the condition has had a big impact on tribal health systems. The IHS was formed to provide healthcare on or near Native American and Alaska Native communities, often on reservations, but continues to be underfunded.

Prevention and Management Efforts

Culturally grounded diabetes prevention and management programs can support Native American and Alaska Native communities. These efforts can help prevent type 2 diabetes, improve blood glucose control, and reduce complications. Health experts and tribal leaders have identified several promising approaches.

Traditional Foods

Many Native American and Alaska Native communities have limited access to fresh, whole foods. Research suggests that more traditional, diverse eating patterns may help prevent diabetes. Some tribal programs aim to help people return to this way of eating.

Physical Activity

Increasing physical activity can also reduce diabetes risk. Research shows that Native Americans who spend time with people who exercise are more likely to be physically active themselves.

Community-Led Wellness Programs

Many Native American and Alaska Native communities offer wellness programs focused on diabetes prevention and management. These initiatives allow tribal communities to set goals that reflect their culture, values, and needs.

Some programs receive federal funding or grants. For example, the Special Diabetes Program for Indians has been linked to recent declines in kidney disease and other diabetes-related complications in Native American and Alaska Native communities.

Talk to Your Doctor

If you’re concerned about your family’s risk of type 2 diabetes, talk with your doctor or healthcare team. They can answer your questions about blood glucose, lifestyle changes, and ways to lower your risk of complications.

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