Transcript Diabetes Prevention Ann Albright, PhD, RD Director, Division of Diabetes Translation

Diabetes Prevention
Ann Albright, PhD, RD
Director, Division of Diabetes Translation
The findings and conclusions in this presentation are those of the author and do not necessarily represent the views of the CDC.
24 million
with Diabetes
57 million
with Prediabetes
What Are Our Chances of Developing
Diabetes?
 Lifetime – from birth till death
o
33% (male), 39% (female)
 Annual – adults
o
~ 1%
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)
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)
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)
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 346:393-403, 2002
Intervention Impact by Ethnicity
Cases/100 person-yr
Lifestyle
Metformin
Placebo
12
8
4
0
Caucasian African
(n=1768) American
(n=645)
The DPP Research Group, NEJM 346:393-403, 2002
Hispanic
(n=508)
American
Indian
(n=171)
Asian
(n=142)
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
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
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.
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
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
Prevention of Type 2 Diabetes
The Community – Clinic Partnership Model
Community
Insurers
}
Employers
Informed Population
Strong Community
Organizations
Partnership Zone
Proactive Practice
Team
Diagnosis of
Pre-diabetes
Decision Support
Reimbursement
Screening for
High Risk
Structured Lifestyle
Programs
Healthy Public
Policy
Supportive Environments
Total Population
Clinic
Information
Systems
Regular
Glucose
Monitoring
Pre-diabetes
Diabetes
Informed,
Activated
Patients
Complications
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)