Finding a Native American in Towaoc, Colo., who does not have diabetes or know someone with diabetes is rare.

"It is the exception," says Gerald Pond, general manager of the Ute Mountain Casino Hotel and Resort.

Pond, whose roots are with the Assiniboine tribe in Montana, comes from a family of nine. Seven members have been diagnosed with type 2 diabetes, he says.

Of the 3.3 million American Indians and Alaska Natives in the United States, about 16 percent have diabetes, most of them type 2, says the Indian Health Service, part of the Department of Health and Human Services. That's almost twice the rate of diabetes as whites.

Thousands of scientists are gathering this weekend in Orlando for the American Diabetes Association's 70th scientific sessions, an annual conference that focuses on advances in diabetes research and the needs of patients, including high-risk groups such as Native Americans and African Americans.

Though the number of diabetes cases in tribal communities is daunting, it's not the end of the story, say many tribal members and health care workers. A number of communities in recent years have taken on diabetes with a vengeance and are reaping healthy results. Individual efforts as well as government grants are helping. Improved access to health care, nutritional counseling in schools and businesses, school mentoring programs and community farming are among the programs making headway.

"Things have been changing. There's a new energy," says Chippewa Ann Bullock, the medical consultant for the Health and Medical Division of the Eastern Band of Cherokee Indians, in Cherokee, N.C. She says tribes have been traumatized historically, but "there's a new sense of hope."

Community leaders such as Pond are bringing about change, too. Pond, 53, says his own diabetes motivated him to revamp the casino buffets with more vegetable choices and fewer fatty and sugary foods, set up a workout room for his security staff, and invite Jan DeLeo, a registered dietitian, to give nutrition seminars to his employees.

"It's for a selfish reason. Healthy employees don't cost as much to employ, they come to work more often, and they do a much better job. But it makes me happy to help them, too," says Pond, who was diagnosed four years ago and has since lost weight and started exercising.

Government financial assistance is easing the problem, too. Since Congress established the Special Diabetes Program for Indians in 1997 in response to the growing epidemic in native populations, diabetes-focused health services in tribal areas are more common.

DeLeo and Mary North, a home health nurse for the Ute Mountain Ute tribe, visit patients, including tribal elder Ira Cuthair, in Towaoc every week. North refills insulin supplies and other medications and takes tribe elders to medical appointments.

Dawn Satterfield, a team leader for the Native Diabetes Wellness Program at the Centers for Disease Control and Prevention's Division of Diabetes Translation, says the CDC has been working with 17 tribal communities to improve access to local, fresh produce. For many people living on reservations, grocery stores can be dozens of miles away.

Preserving and renewing cultural identity is a key feature of the programs, Satterfield says. "We've listened to tribe elders from the beginning, and through our Traditional Foods project, we've honored the concepts of harvesting, gathering and preparing traditional foods like squash and berries," she says.

Other initiatives:

At a meeting of tribal grant recipients this month in Tulsa, the Ramah Navajo tribe reported on its successful composting program to restore the soil so members can grow traditional vegetables.

The Standing Rock Nation, bordering North and South Dakota, is partnering with the U.S. Department of Agriculture, offering fresh-produce vouchers the elderly can use at local farmers markets. Redemption rates are more than 50 percent, Satterfield says.

In North Carolina, the Cherokee Choices program includes mentoring in elementary schools for the most at-risk children, Bullock says. "They teach not only about fruits and veggies but emotional coping tools. They take children on cultural field trips and develop a sense of pride in who they are."

Key to many programs is the rebuilding of pride and self-esteem, and keeping in mind the spiritual component of healing and overcoming diabetes, Bullock says.

As Terry Knight, 61, a Ute Bear Dance Chief who has diabetes explains, the tribe's spirit is the bear: "He represents strength and power and wisdom, the ability to survive against all odds."