Diabetes Prevention

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Diabetes Prevention

• Ann Albright, PhD, RD
• Director, Division of Diabetes Translation

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24 million with Diabetes
57 millionwith Prediabetes
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What Are Our Chances of Developing Diabetes?

• Lifetime from birth till death
• 33 (male), 39 (female)
• Annual adults
• 1

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Intervention Time Window

• Changes in glucose concentrations, insulin
  sensitivity, and insulin secretion as much as 36
  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 lt4.5 years
  (Mason et al. Diabetes 5620542061, 2007)

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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 2007116 July 18
  online)
• Prevalent retinopathy about 8
• (DPP. Diabet. Med. 2007 24137-144)

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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)

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Effect of Treatment on Incidence of Diabetes in
the DPP(All participants had IGT)
Placebo Metformin Lifestyle
Annual Incidence of diabetes 11.0 7.8 4.8
Relative reduction (compared with placebo) ---- 31 58
Number needed to treat (to prevent 1 case in 3 years) ---- 13.9 6.9
The DPP Research Group, NEJM 346393-403, 2002
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Intervention Impact by Ethnicity
The DPP Research Group, NEJM 346393-403, 2002
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Further Benefits of Lifestyle InterventionOther
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 2728 ? for hypertension
  and 25 ? for
• hyperlipidemia compared with placebo and
  metformin groups

DPP. Diabetes Care 28888894, 2005
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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

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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.

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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

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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

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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
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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)