Diabetes Education and Research Programs in the USA Michael M. Engelgau Centers for Disease Control and Prevention Atlanta, Georgia, USA

National Diabetes Education Program Changing the Way Diabetes Is Treated

NDEP structure Partnership between CDC and National Institute of Health (federal) CDC and National Institute of Health (federal) Over 200 others Over 200 others State Diabetes Control Programs State Diabetes Control Programs Public and private organizations Public and private organizations Traditional and non-traditional partners Traditional and non-traditional partners (eg National Urban League) (eg National Urban League)

Program Goal To reduce the illness and deaths associated with diabetes and its complications by changing the way diabetes is treated

Program Objectives Population Increase awareness of: Seriousness Seriousness Risk factors Complications Prevention Prevention Persons with diabetes Improve understanding and control Improve understanding and control Health care providers Improved understanding Improved understanding Promote integrated care Promote integrated care Health care policy Improve quality and access

5 Core Components of NDEP Awareness Campaigns Special Populations Community Interventions Partnership Network Health Systems

Target Audiences - caveats Higher prevalence groups Members of the social support systems Health care providers Payers, purchasers, and policy makers People at high risk for diabetes

Three overarching campaigns

NDEP Workgroups Health Care ProviderHealth Care Provider Older AdultsOlder Adults Team CareTeam Care Children and AdolescentsChildren and Adolescents Business and Managed CareBusiness and Managed Care PPOD ( Pharmacy, Podiatry, Optometry and Dental professionals)PPOD ( Pharmacy, Podiatry, Optometry and Dental professionals) African AmericanAfrican American American Indian/Alaska NativeAmerican Indian/Alaska Native Hispanic/LatinoHispanic/Latino Asian American/Pacific IslanderAsian American/Pacific Islander Community InterventionsCommunity Interventions EvaluationEvaluation

Take Care of Your Heart English, Spanish, and 15 Asian and Pacific Islander languages

High Risk Populations

Asian American and Pacific Islander subcommittee Asian American Heritage Month (May) publicityAsian American Heritage Month (May) publicity Translation of ABC campaign and other NDEP materials languagesTranslation of ABC campaign and other NDEP materials languages Designing community interventions for AAPIDesigning community interventions for AAPI Grant application toolkit for grassroots CBOsGrant application toolkit for grassroots CBOs Position paper on diabetes and AAPIPosition paper on diabetes and AAPI Fact sheets for health care providers on diabetes and AAPI populationFact sheets for health care providers on diabetes and AAPI population Strengthen bond with ADA targeting AAPIStrengthen bond with ADA targeting AAPI

Asian American / Pacific Islander

At risk BMI chart different for Asians and Pacific Islanders

Take Care of Your Heart

New products from the Asian American/Pacific Islander workgroup Silent Trauma: Diabetes, Health Status and the Refugees Experience among Southeast Asians in the United States Capacity Building for Diabetes Outreach: a Comprehensive Toolkit for Organizations Serving the Asian and Pacific Islander Community

State Diabetes prevention and Control Program Partnerships DPCPs adapt NDEP materials for local needs

Business Partners

Target Users Senior managers at large and small employersSenior managers at large and small employers Human resource managers and wellness professionalsHuman resource managers and wellness professionals Occupational health care providersOccupational health care providers Diabetes educatorsDiabetes educators Managed care and benefit professionalsManaged care and benefit professionals

National and International Partnerships National Urban League PAHO Khmer Health Advocates Pap Ola Lakahi

NDEP funds National Organizations serving Ethnic Minorities funding: American Association of Indian PhysiciansAmerican Association of Indian Physicians Black Women ’ s Health ImperativeBlack Women ’ s Health Imperative Khmer Health AdvocatesKhmer Health Advocates National Alliance of Hispanic HealthNational Alliance of Hispanic Health National Association of School NursesNational Association of School Nurses National Latina Health NetworkNational Latina Health Network National Medical AssociationNational Medical Association Papa Ola LakahiPapa Ola Lakahi

Research Programs Basic Research Applied Research Clinical Investigations and Trials Demonstration and Education Research Knowledge Acquisition Knowledge Validation Knowledge Transfer Knowledge Dissemination

“Science is the underpinning for good public health policy.” David Satcher, MD, PhD Former US Surgeon General Former US Surgeon General

CDC Approach Identify emerging public health problems Identify emerging public health problems Identify opportunities for prevention and improving quality of life Identify opportunities for prevention and improving quality of life Address disparities Address disparities Engage partners - public and private sector Engage partners - public and private sector Bridge from epidemiology to public health Bridge from epidemiology to public health

Science of Public Health Surveillance and Burden Assessment Surveillance and Burden Assessment Translation Research Translation Research Economics and Policy Economics and Policy

SurveillanceSurveillance Need to KNOW

Diabetes Surveillance 21 st Century Morbidity and mortalityMorbidity and mortality Glucose, blood pressure, and lipid controlGlucose, blood pressure, and lipid control Risk factors for diabetesRisk factors for diabetes Inequities in health statusInequities in health status Access to and quality of careAccess to and quality of care Quality of lifeQuality of life Diabetes in childrenDiabetes in children

What are the Goals of Translational Research? äTo assess the level and quality of care äIdentify barriers to improvement äTo identify and test change strategies aimed at achieving optimal care Narayan KMV et al Diabetes Care 2002

Characterizing the Problem Understanding the solution Etiological Reseach Public Health Surveillance Basic science/ Epidemiology Clinical Trials

Characterizing the Problem Understanding the solution Etiological Research Public Health Translation Research Translation Research Surveillance Basic science/ Epidemiology Clinical Trials

Structural Factors Processes of Care (Quality of Care) Health Outcomes Ability to track, risk stratify, and manage members with diabetes Guideline implementation Patient education resources Managed care experience Management of referral care Clinician incentives Financial barriers to care Non-financial barriers

EconomicsEconomics Limited resources Limited resources “Opportunity” costs “Opportunity” costs Value concept Value concept Essential for sound health policy decisions Essential for sound health policy decisions

Examples of Economic Studies for Diabetes Control Cost effectiveness Screening for undiagnosed diabetes Intensive treatment for: Glycemia Blood pressure Lipids Smoking cessation Optimization of care delivery Primary prevention of diabetes

Summary Education programs Broad scope and members Many dimensions Target to groups Dynamic Research Programs Describe burden Make operational the “solution” Make the case for effective policy