The medicine wheel nutrition intervention: a diabetes education study with the Cheyenne River Sioux Tribe

J Am Diet Assoc. 2009 Sep;109(9):1532-9. doi: 10.1016/j.jada.2009.06.362.


Objective: The Northern Plains Indians of the Cheyenne River Sioux Tribe have experienced significant lifestyle and dietary changes over the past seven generations that have resulted in increased rates of diabetes and obesity. The objective of this study was to determine if Northern Plains Indians with type 2 diabetes mellitus who are randomized to receive culturally adapted educational lessons based on the Medicine Wheel Model for Nutrition in addition to their usual dietary education will have better control of their type 2 diabetes than a nonintervention, usual care group who received only the usual dietary education from their personal providers.

Design: A 6-month, randomized, controlled trial was conducted January 2005 through December 2005, with participants randomized to the education intervention or usual care control group. The education group received six nutrition lessons based on the Medicine Wheel Model for Nutrition. The usual care group received the usual dietary education from their personal providers.

Participants: One hundred fourteen Northern Plains Indians from Cheyenne River Sioux Tribe aged 18 to 65 years, with type 2 diabetes.

Methods: Weight, body mass index (BMI), hemoglobin A1c, fasting serum glucose and lipid parameters, circulating insulin, and blood pressure were measured at the beginning and completion. Diet histories, physical activity, and dietary satiety surveys were measured at baseline and monthly through completion. Differences were determined using Student t tests, chi(2) tests, and analysis of variance.

Results: The education group had a significant weight loss (1.4+/-0.4 kg, P<or=0.05) and decrease in BMI (1.0+/-0.1, P<or=0.05) from baseline to completion. The usual care group had no change in weight (0.5+/-0.5 kg) or BMI (0.5+/-0.2). There were no between group differences due to intervention in energy, carbohydrate, protein, and fat intake and physical activity.

Conclusions: The culturally based nutrition intervention promoted small but positive changes in weight. Greater frequency and longer duration of educational support may be needed to influence blood glucose and lipid parameters.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Blood Glucose / metabolism
  • Body Mass Index
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / ethnology
  • Diabetes Mellitus, Type 2 / prevention & control*
  • Diet / ethnology*
  • Female
  • Health Education / methods*
  • Humans
  • Indians, North American*
  • Life Style
  • Lipids / blood
  • Male
  • Middle Aged
  • Nutrition Policy
  • Nutritional Sciences / education*
  • Obesity / blood
  • Obesity / ethnology
  • Obesity / prevention & control*
  • Patient Compliance
  • Weight Loss / physiology
  • Wyoming
  • Young Adult


  • Blood Glucose
  • Lipids