Monitoring Progress Toward Diabetes Prevention

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Monitoring Progress Toward Diabetes Prevention

• Diabetes Primary Prevention Initiative
• Surveillance Focus Area
• May, 2008

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Diabetes Prevention Control Programs

• Conduct Surveillance
• Lead coordinate strategic planning
• Implement, support, and coordinate diabetes
  public health strategies

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DPPI Surveillance Goal

• To recommend a surveillance system to monitor
  populations with prediabetes or at risk for
  diabetes
• The system should be
• State-based
• Replicable by most DPCPs
• Address all ages
• Incorporate multiple settings

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Proposed Diabetes Prevention Goals

• Prevent or delay the onset of diabetes in persons
  with diagnosed prediabetes or a history of
  gestational diabetes (GDM).
• Person with high blood glucose levels are
  diagnosed.
• Persons with prediabetes or GDM are achieving
  recommended behaviors and care practices.

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Populations for Surveillance

• At risk for developing diabetes
• age, non-white, body mass index, central
  adiposity, family history, high blood pressure,
  high blood glucose, prior history of high
  glucose, physical inactivity, history of CVD
• Prediabetes
• Impaired Glucose Tolerance (IGT) and/or
• Impaired Fasting Glucose (IFG)
• Gestational Diabetes Mellitus

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Population at risk for prediabetes/diabetes

• 45 years, obese, family history of diabetes,
  sedentary, HBP, HChol, history of CVD, non-white
• Multivariate regression algorithm based on
  self-report data that can be used to identify
  prediabetes/diabetes population. (California)
• Track blood glucose testing, risk factors, and
  risk behaviors in the at risk population.
• PRODUCT Toolkit with regression equation, code
  to run with state BRFSS data, examples of how to
  use.

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Awareness of Diabetes Prediabetes Minnesota
2007
Have you ever been told by a doctor or other
health professional that you have prediabetes or
borderline diabetes?
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Gestational Diabetes

• BRFSS History of GDM 25-55 yrs 8
• Birth certificates
• Hospital discharge data
• Pregnancy Risk Assessment Monitoring
• New PRAMS measures beginning 2009
• GDM follow-up survey (MA2008)
• GDM Surveillance Sources Issues
• Validation studies

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Ecologic Model

• Macro
• Societal norms
• Policies
• Land use
• Physical
• Communities
• Work-sites
• School
• Social
• Family
• Friends
• Peers
• Individual
• Demographics
• Biological
• Behaviors
• Cognitions

Macro-level (sectors)
Physical (settings)
Social (networks)
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Community and Environmental Massachusetts 2007
Community Survey

• Assess health-related community and environmental
  policies and programs.
• Based on CDC Community Guide.
• Access to physical activity facilities
• Access to healthy foods
• Local policies and ordinances that facilitate
  active and healthy community environments
• Local development
• Emergency response/preparedness

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Massachusetts2007 Community Survey

• Administered to Town administrator, town clerk,
  public health agent, parks and rec, public
  works/highway officials, town planners.
• Web-survey with mail, fax, and telephone
  follow-up.
• PRODUCT Survey methodology, key measures
  supported by promising evidence

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Community and Environmental

• Common Community Measures for Obesity (COCOMO)
• RWJF, Kaiser, Kellogg, CDC Foundation, CDC DNPAO
• Evidence-based strategies ? key indicators
• Assessment, evaluation, research
• ACHIEVE
• Community Assessment
• CDC DACH

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Individual-level indicatorsSurveys General
diabetes

• 1st degree family history of diabetes
• History of gestational diabetes
• Blood glucose testing in the past 3 years
• Diabetes Prevention Module, DIDIT
• Told at risk for diabetes
• Practice healthy lifestyles to prevent/ control
  diabetes

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Individual-level indicatorsSurveys Specific
prediabetes

• Were you ever toldprediabetes/borderline DM
• Diabetes prevention module, DIDIT
• Were you told in the past 12 months
• Incidence
• Have a blood glucose test in the past 12 months
• Are you currently taking medications for
  prediabetes?
• Age first told you had prediabetes
• Duration
• Incidence

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Duration of Prediabetes Diabetes

• Duration Prediabetes() Diabetes()
• 2006 2007 2006 2007
• 0 yr 19.6 17.1 2.6 4.3
• 1 yr 25.2 19.3 9.8 6.5
• 2 yrs 15.9 12.5 9.4 8.0
• 3 yrs 8.2 9.8 8.1 8.3
• 4 yrs 5.3 3.4 6.8 8.1
• 5 yrs 6.9 2.8 5.9 5.7
• 6 yrs 18.2 35.0 59.5 59.2
• Range (yrs) 6-49 6-56 6-59 6-62

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Individual-level IndicatorsGeneral chronic
disease risk Existing

• Fruits and vegetables consumption
• Physical activity No LTPA, moderate, vigorous
• Body mass index
• Smoking status
• Weight change
• High blood pressure
• High blood cholesterol
• Health care access
• Health care provider visits, immunizations,
  dental
• Health status
• Comorbity CVD, arthritis, asthma, mental health

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Individual-level indicatorsGeneral Chronic
Disease Risk

• Increase fruit and vegetable consumption
• Reduce calories in diet
• Increase physical activity
• Increase walking
• Television viewing
• Computer use
• Sleeping
• Participate in a weight management program
• Insurance coverage for wt. mgmt program
• Told by doctor or HP to a) control or lose
  weight, b) increase PA or exercise, c) reduce
  amount of fat in diet
• Participate in wellness program to prevent
  chronic diseases

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Reduced calories in the past 12 months
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Increased Walking in the Past 12 Months
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DPPI Surveillance Products

• Framework for diabetes prevention surveillance.
• DIDIT descriptions for Diabetes Prevention Module
  measures.
• Logistic regression algorithm to identify high
  risk population using BRFSS self-report measures.
• Set of developed and tested survey measures for
  BRFSS and mail surveys.
• MA Community Survey
• List of resources and ongoing activities related
  to diabetes prevention.

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Participants

• California Gary He, David Rocha, Matt Stone
• Massachusetts Brianne Beagan, Nidu Menon
• Minnesota Jay Desai, Nagi Salem
• CDC DDT Qaiser Mukhtar, Linda Geiss, Ed Gregg,
• Liping Pan, Xuanping Zhang, Carmen Harris
• CDC Stat Consultants David Williamson, Ted
  Thompson, Bob Gerzoff
• CDC DNPA Michelle Maynard, Janet Fulton, Laura
  Kettle-Khan
• RTI Amanda Honeycutt, Jeanette Renaud

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Objectives

• Determine a framework for diabetes prevention
  surveillance.
• Identify and prioritize potential indicators for
  diabetes prevention.
• Determine methods to measure diabetes prevention
  indicators.
• Pilot selected diabetes prevention indicators.
• Coordinate with related surveillance activities.

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Diabetes Prevention Surveillance

• Determine the magnitude and distribution of
  behaviors, factors, and conditions.
• Assess change over time.
• Evaluate population-based prevention control
  strategies.
• Facilitate program planning policy decisions.
• Monitor progress toward local, state, and
  national objectives.

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Domains for Diabetes Prevention Surveillance
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ICD-9-CM codes

• Diabetes 250.00 250.93
• Impaired Fasting Glucose 790.21
• Impaired Glucose Tolerance 790.22
• Abnormal glucose during pregnancy 678.20
• Metabolic syndrome 277.7
• Obesity 278.00, 278.01, 783.1

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State-level Data Sources

• Surveys
• Behavioral Risk Factor Surveillance Survey
• Pregnancy Risk Assessment Monitoring System
• Community
• Work-site
• Birth certificates
• Claims data
• Hospital discharge data
• Medicare data
• Medicaid data
• Health insurer claims
• Electronic Medical Record