Alliance to Reduce Disparities in Diabetes

Reducing Diabetes Disparities in American Indian Communities (Wind River Reservation)


The Eastern Shoshone Tribe of the Wind River Indian Reservation is collaborating with the Northern Arapaho Tribe, the Wind River Indian Health Service, the state of Wyoming Department of Health and Sundance Research Institute. This group created and is supporting a comprehensive, community-health system partnership to improve outcomes for American Indian people with diabetes and to reduce the substantial health disparities experienced by American Indians. The program approach encompasses individuals, providers and the overall health system to assist individuals in making lifestyle changes to manage their diabetes, increase the effectiveness of communications between health care providers and patients, and extend and increase resources through improved coordination and collaboration among diabetes services at the Tribal, federal and state levels.


  • Work to decrease the substantial health disparities experienced by American Indians
  • Increase the skills of health care workers (professional and lay) who assist patients in managing their diabetes
  • Strengthen the health system and community support system to serve people with diabetes


The conceptual framework for the program combines elements of the Chronic Disease Management Model and the Tribal Participatory Approach to implement effective programs for reducing health disparities. Major components of the program include:

  • Establish the Wind River Indian Reservation Diabetes Working Group comprised of Tribal leaders, Tribal health directors, Tribal diabetes program managers, lay health educator managers and Indian Health Service (IHS) diabetes providers and staff.
  • Integrate and coordinate program activities with the IHS Quality Improvement Initiative for Chronic Care Management
  • Conduct a community-wide education campaign on diabetes, prediabetes and the benefits of lifestyle changes for prevention and management of diabetes.
  • Provide extensive training on diabetes and diabetes self-management education for Tribal health, diabetes and outreach staff.
  • Conduct workshops on Tribal culture, traditions, health beliefs and attitudes. Additional workshops include patient-provider communication and health literacy issues for IHS.
  • Improve coordination and collaboration among Tribal, IHS, and state diabetes programs and staff, including sharing resources and facilitating access to care.
  • Recruit Tribal members with diabetes or diagnosed with prediabetes to participate in diabetes self-management education classes. Provide intensive follow-up to program participants and
    family members for a six-month period after completion of formal classes to provide encouragement, assist with problem solving and goal setting and facilitate lifestyle changes.


  • 216 people with diabetes have completed Diabetes Self-Management Education (DSME) classes and each person who completed DSME classes received a monthly follow-up in order to encourage lifestyle changes and promote education and support.
  • A well-attended workshop was conducted for health providers and IHS staff on Eastern Shoshone and Northern Arapaho tribal history, culture, and traditions with a focus on improving communications and interaction with patients.
  • The Wind River team is now providing individual-level in-home DSME classes for people with diabetes and their families who were unable to attend the group classes.
  • A Life Style Balance program focusing on exercise and nutrition was initiated for Tribal members diagnosed as pre-diabetic and referred by IHS. Tribal gym staff members provide exercise guidance throughout the program. Thus far, 40 people have completed this new program.

Affiliated Sites:

For more information on the Wind River Indian Reservation's role on the Alliance to Reduce Disparities in Diabetes, please contact Charles Aragaon at