Translating Science Into Clinical Practice in Diabetes

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Translating Science Into Clinical Practice in
Diabetes

• Irene Heaston, MSN, RN
• Michelle Owens, PhD
• Magon M. Saunders, MS, RD, LD
• Centers for Disease Control and Prevention
• Division of Diabetes Translation

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Objectives

• Describe key results of landmark studies in
  diabetes care and prevention
• Discuss how this information impacts clinical
  practice in managing patients with or at high
  risk for diabetes
• Discuss free resources from the National Diabetes
  Education Program to help in patient education,
  with a specific focus on African Americans.

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Background

• Diabetes costs over 174 billion annually
• Almost 24 million people in the United States
  have diabetes
• Another 57 million have pre-diabetes

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Racial and ethnic minorities are especially hard
hit by diabetes.
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Impact of Diabetes on African Americans

• Approximately 3.2 million or 13.3 of African
  American aged 20 years or older have diabetes
• For those born in 2000, 13 will develop diabetes
  
• African Americans are 1.8 times more likely to
  have diabetes than Non- Hispanic Whites

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Diabetes Control andComplications Trial (DCCT)

• Compared effects of two diabetes treatment
  regimens
• standard therapy
• intensive control
• on the complications of diabetes

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DCCT Study Findings

• Glucose control is key to preventing or delaying
  diabetes complications.
• Any sustained lowering of blood glucose helps,
  even if the person has a history of poor control.

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DCCT Study Findings

• Intensive lowering blood glucose reduced risk of
• Eye disease 76
• Kidney disease 50
• Nerve disease 60

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United Kingdom ProspectiveDiabetes Study (UKPDS)

• Clinical trial
• Looked at intensive management of blood glucose
  levels and long-term risk factors for diabetes
  complications

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UKPDS Findings

• Mirrored the findings of DCCT in
• people with type 2 diabetes
• Better glucose control
• Reduced development of microvascular
  complications
• Demonstrated the need for management of high
  blood pressure and cholesterol as well
• as blood glucose levels

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UKPDS Findings

• 1 decline in A1c provided the following risk
  reduction
• Microvascular diseases- 37
• Peripheral Vascular Disease- 43
• Myocardial Infarction -14 reduction
• Strokes- 12
• Heart Failure -10
• Cataract extractions- 19

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Diabetes Prevention Program (DPP)

• 27 clinical sites
• 3,234 subjects with IFG/IGT
• BMI gt 24
• 3 group randomized clinical trial
• 1 control group
• standard lifestyle modification
• 2 treatment groups
• metformin
• intensive lifestyle modification

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DPP Study Population
Asian 4
Caucasian 1768 African-American
645 Hispanic-American 508 Asian-American
142 Pacific Islander American Indian
171
American Indian 5
Hispanic American 16
African American 20
Caucasian 55
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Diabetes Prevention Program (DPP) Findings

• Lose 5 to 7 percent of body weight by
• Getting 30 minutes of physical activity,
• 5 days a week
• Following a low-fat, low-calorie eating plan

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DPP Lifestyle Intervention worked for

• All ethnic/racial groups
• Men and women, lean, plump or fat
• All adults, especially those over age 60
• There is special urgency for the high-risk!

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Discussion

• Based on the reviewed studies, it has been
  confirmed that type 2 diabetes can be prevented
  or delayed by clinical interventions.

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Translating Science into Action

• The National Diabetes Education Program (NDEP)
  has successfully translated science into action,
  by developing products and materials to raise
  awareness about diabetes prevention and control.

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NDEP structure

• Partnership between two federal agencies, Centers
  for Disease Control and Prevention and National
  Institutes of Health, and over 200 partners
• 59 State Diabetes Prevention and Control Programs
• Public and private organizations
• Traditional (e.g., American Diabetes Association)
  and non-traditional
• (National Urban League) partners

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Primary diabetes prevention

• The NDEP primary prevention campaign was
  developed to raise awareness of the Diabetes
  Prevention Program (DPP) results and translate
  results into tools for people at high risk and
  health care providers.

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High Risk Populations
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Focus group research with African Americans

• Fatalistic attitude that diabetes is inevitable
  is common
• Diabetes viewed by African Americans as less
  serious than other health concerns (e.g., HIV,
  cancer)
• Many barriers to changing behavior around food
  and physical activity

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Focus group recommendations

• Teach people how to lose weight and eat
  healthfully
• Messages should be simple, direct, tied to
  consequence of having diabetes
• Importance of family involvement and peer support
• Counter pessimism about being able to make
  changes
• Need options different things work for
  different people
• Address both people with diabetes and those at
  risk

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African American/African Ancestry Workgroup
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African American/African Ancestry
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Now Available
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Power To Prevent A Family Lifestyle Approach to
Diabetes Prevention

• Community education intervention for the family
  that focuses on
• Physical activity
• Healthy eating, and
• Incorporates DPP results
• Uses existing tried-and-proven NDEP tools such as
  the GAME PLAN toolkit materials (Fat and Calorie
  Counter, Food and Activity Tracker)

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Curriculum organization

• Twelve 60-90 minute modules
• Suggestion modules once/week for 6 weeks then
  once/month
• Uses Adult Learning Theory
• Behavioral approach based on the DPP experience
• Use curriculum to guide small groups through
  measuring, learning, practicing and maintaining
  healthy behavior changes.

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Conclusions

• NDEP creates products and tools based on the
  latest science on diabetes prevention and control
  and from input received from focus group
  participants
• Pilot testing materials has aided NDEP in
  understanding the needs of various populations
  and in targeting specific groups
• Innovative materials specifically designed to
  reach African Americans will help health care
  providers in providing patient education to this
  population.

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• Visit the NDEPs Web sites
• www.ndep.nih.gov www.cdc.gov/diabetes/ndep
• www.diabetesatwork.org
• www.betterdiabetescare.nih.gov
• Call 1-800-438-5383

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Contact Information

• Irene Heaston
• 770-488-5062
• Iheaston_at_cdc.gov
• Michelle Owens-Gary, PhD
• 770-488-5014
• MOwens1_at_cdc.gov
• Magon Saunders, MS, RD, LD
• 770-488-5214
• MSaunders_at_cdc.gov