Diabetes mellitus in American Indians - standards for diagnosis and management.
In most American Indian tribes the frequency of diabetes mellitus is much greater than among the non-Indians, and surveillance of health records has shown that many types of illnesses occur more often in the diabetics than in the nondiabetics. Standards, or guidelines, have been developed for diabetes detection and treatment for purposes of limiting diabetes diagnoses to persons with high probabilities of having the disease and concentrating diabetes case finding among high-risk groups or individuals. The guidelines emphasize that early diagnosis and careful management of diabetic pregnancies can decrease rates of macrosomia, congenital malforamtions, spontaneous abortion, stillbirth, and neonatal death. Diabetes management is based on staging criteria and requires trained paramedical workers in many aspects of management of asymptomatic diabetics, while the physicians concentrate more extensively on diabetes with symptoms and remediable complications.