1. 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

2. 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.

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

4. 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

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

7. 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?

9. 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

11. 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.

12. 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

14. 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.

16. 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):
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):