INTRODUCTION
The prevalence of metabolic glucose disorders in American Indians has been investigated by community survey techniques since the early 1960s for tribes located in the southwestern United States, e.g., Arizona, Oklahoma, New Mexico, Colorado. Very few survey results were published for tribes in other location. In the northwestern United States, only one unpublished survey report from the Warm Springs Reservation exists. The incidence and/or prevalence of diabetes in the tribes studied varied with the specific decade, the specific methods used for the survey, and the tribes involved; therefore, comparisons between decades and tribes are impossible, and generalizations are difficult.
The problem during the early years of surveys for diabetes among American Indian groups was to distinguish between two explanations for the comparatively high rates of diabetes. Either the disease was a new epidemic response of a population rather suddenly exposed to a constant food supply, or somehow American Indians had developed a resistance to the effects of hyperglycemia and therefore did not exhibit the same frequency of symptoms and common complications of prolonged diabetes found among other populations. Indeed, early investigators were hesitant to label persons “diabetic” with plasma sugar levels that averaged over 250 mg. percent two hours following a glucose load of 75 grams in spite of confirmation by standard glucose tolerance tests. Such early titles in the literature as ”The High Prevalence of Abnormal Glucose Tolerance in the Cherokee Indians of North Carolina,”’ and ”Hyperglycemia in Pima Indians” (emphasis mine) reflect this bias. These early papers reflect the viewpoint that a “special Indian” diabetes existed, presumably devoid of the complications of blindness, renal failure, amputations, and acidotic coma, although Miller et al. in 1968 did find evidence of early retinal changes, cataract formation, kidney function decrease, and other secondary complications from diabetes of long duration.
