SPECIAL DIABETES PROGRAM FOR INDIANS Diabetes Prevention Program: Design Strategies CRISP D&I Training Workshop 2013 SPECIAL DIABETES PROGRAM FOR INDIANS Diabetes Prevention Program: Translating research into practice for American Indians/Alaska Natives with Pre-Diabetes Spero M. Manson, Ph.D. Distinguished Professor and Director Centers for American Indian and Alaska Native Health www.ucdenver.edu/implementation

Background In 2009, the rate of diabetes for adults eligible for Indian Health Service was 16.1%, more than twice that of non-Hispanic White adults. Cardiovascular disease is the most serious, debilitating and costly complication of diabetes among American Indian adults. IHS treatment costs for the 10.9% of American Indian adults with diabetes account for 37.0% of all adult treatment costs, nearly twice the relative cost seen in the general population. www.ucdenver.edu/implementation

Developing Partnerships Balanced Budget Act 1997 Prevention/Treatment of Diabetes in AIANs Administered by the Indian Health Service www.ucdenver.edu/implementation

Developing Partnerships 2002 Reauthorization Congressional direction – develop a competitive grant program to demonstrate diabetes prevention and also address the most compelling complication of diabetes (cardiovascular disease) Evaluation required SDPI Demonstration Projects SDPI Diabetes Prevention Program (DP) – 36 programs Collaborative development of activities Comprehensive Program Evaluation Coordinating Center – University of Colorado Denver www.ucdenver.edu/implementation

Timeline 2003 RFA, Selection of Programs 2004-2005 Planning Year 2005-2010 Demonstration Project Activities and Evaluation 2010 Institutionalization 2014 Dissemination

www.ucdenver.edu/implementation

Agenda Setting Based on NIH Diabetes Prevention Program (DPP) research study The DPP study found that it is possible to prevent Type 2 diabetes in persons at high risk through: weight loss (goal of 7%) physical activity (goal of 150 min/week), and healthy eating habits Proven effective in the general population: what about AI/AN communities? www.ucdenver.edu/implementation

Agenda Setting Diabetes Prevention Program Screen to find AI/AN people with pre-diabetes Recruit and enroll eligible participants 16 session DPP Lifestyle Balance curriculum in group sessions Individual lifestyle coaching sessions, physical activity programs, and follow-up support to reinforce curriculum Retention/After Core Community activities www.ucdenver.edu/implementation

Preliminary results – good progress Many lessons learned during the planning, implementing, and data collection process – will be very helpful for the planning of future similar projects.

Developing the Intervention Planning Year Six 2½ day meetings of grantees Systematic review of Lifestyle Balance Curriculum Close consultation with NIDDK DPP staff who mounted American Indian sites Numerous panels of SDPI grantee staff to address content, format, delivery, and duration Flexible uniformity: achieving locally meaningful fidelity Full participation in evaluation design Capacity building: staff, program, leadership www.ucdenver.edu/implementation

Lessons Learned EVERYTHING has to be understood and rendered meaningful in local terms Peer-to-peer learning is critical Compromise and negotiation are as much art as science “Success only precedes work in the dictionary. www.ucdenver.edu/implementation

References Jiang L, Manson SM, Beals J, Henderson WG, Huang H, Acton KJ, Roubideaux Y. Translating the Diabetes Prevention Program into American Indian and Alaska Native communities. Diabetes Care, 2013, 36(Jul): 2027-34. Jiang L, Beals J, Zhang L, Mitchell CM, Manson SM, Acton KJ, Roubideaux Y. & Special Diabetes Program for Indians Demonstration Projects. Latent class analysis of Stages of Change for multiple health behaviors: Results from the Special Diabetes Program for Indians Diabetes Prevention Program. Prev Science, 2012, 13:449–461. O’Connell J, Wilson C, Yi R, Manson SM, Acton KJ. The costs of treating American Indian adults with diabetes within the Indian Health Service. AJPH, 2012, 102(2):301-308. www.ucdenver.edu/implementation