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Diabetes Prevention

Diabetes Prevention . Ann Albright, PhD, RD Director, Division of Diabetes Translation. 24 million with Diabetes. 57 million with Prediabetes. What Are Our Chances of Developing Diabetes ?. Lifetime – from birth till death 33% (male), 39% (female) Annual – adults ~ 1%.

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Diabetes Prevention

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  1. Diabetes Prevention Ann Albright, PhD, RD Director, Division of Diabetes Translation

  2. 24 millionwith Diabetes 57 millionwith Prediabetes

  3. What Are Our Chances of Developing Diabetes? • Lifetime – from birth till death • 33% (male), 39% (female) • Annual – adults • ~ 1%

  4. Intervention Time Window • Changes in glucose concentrations, insulin sensitivity, and insulin secretion as much as 3–6 years before diagnosis of diabetes in British Civil Servants (Tabek, et al. Lancet, 2009) • In Pima Indians the timeframe over which glucose values rose suddenly was estimated at <4.5 years (Mason et al. Diabetes 56:2054–2061, 2007)

  5. Other “Complications” of Pre-diabetes • 5-year risk of total mortality increased 50-60% • 5-year risk of CVD mortality increased 150% (Barr et al. Circulation 2007;116: July 18 online) • Prevalent retinopathy about 8% (DPP. Diabet. Med. 2007: 24:137-144)

  6. Lifestyle Intervention Trials(All participants had pre-diabetes) • Pan et al. (1997) • Tuomilehto et al. (2001) • DPP Research Group (2002)*** • Kosala et al. (2005) • Ramachandran et al (2006)

  7. Effect of Treatment on Incidence of Diabetes in the DPP(All participants had IGT) The DPP Research Group, NEJM 346:393-403, 2002

  8. Intervention Impact by Ethnicity The DPP Research Group, NEJM 346:393-403, 2002

  9. Further Benefits of Lifestyle Intervention:Other CVD risk factors are also improved • Hypertension was present in 30% of subjects at entry - then ↑ • in placebo and metformin groups, significantly ↓ with lifestyle • TG levels ↓ in all treatment groups, but ↓ significantly more with • lifestyle intervention • Lifestyle intervention significantly ↑ HDL level and ↓ LDL • At 3 yr F/U the use of medications to achieve goals in the • lifestyle group was 27–28% ↓ for hypertension and 25% ↓ for • hyperlipidemia compared with placebo and metformin groups DPP. Diabetes Care 28:888–894, 2005

  10. US Research Studies that have Translated the DPP Trial Lifestyle Intervention • 13 studies • Core sessions ranged from 16 to 6 • Mean sessions attended • 16 sessions (9-14) • 12 sessions (7-9) • 11 sessions (8) • Weight Loss: 6% - 2.7% • The more sessions attended the greater the wt. loss

  11. National Diabetes Prevention Program • Goal: • Systematically scale the translated model of the Diabetes Prevention Program (DPP) for high risk persons in collaboration with community-based organizations that have necessary infrastructure, health payers, public health, academia, and others to reduce the incidence of type 2 diabetes in the United States.

  12. Four Key Pillars (1) Training the work force that can implement the program cost effectively CDC established the Diabetes Training and Technical Assistance Center (2) Implementing a recognition program that will contribute to assuring quality, lead to reimbursement, and allow CDC to develop a registry of programs for public reporting CDC currently developing the criteria for program recognition – expected final draft Sept 2010

  13. Four Key Pillars (3) Implementing sites that will build the infrastructure and some will provide a “laboratory” for additional refinement of this prevention system CDC and Y-USA announced 11 model sites Y-USA and UnitedHealth Group (UHG) announced 6 model sites (4) Increasing referrals and utilization of the prevention system through health marketing and other strategies CDC contracted with MACRO – formative PR/marketing work and UHG is doing focus group testing

  14. Prevention of Type 2 DiabetesThe Community – Clinic Partnership Model Community Clinic Insurers Partnership Zone } Employers Proactive Practice Team Reimbursement Screening for High Risk Informed Population Diagnosis of Pre-diabetes Decision Support Strong Community Organizations Structured Lifestyle Programs Information Systems Healthy Public Policy Informed, Activated Patients Regular Glucose Monitoring Supportive Environments Total Population Complications Pre-diabetes Diabetes

  15. Community and policy System, group, culture Family, friends, small group Individual The health of individuals is inseparable from the health of communities (Healthy People 2010)

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