1. The findings and conclusions in this presentation are those of the author and do not necessarily represent the views of the CDC. Diabetes Prevention Ann Albright, PhD, RD Director, Division of Diabetes Translation Ann Albright, PhD, RD Director, Division of Diabetes Translation

2. 24 million with Diabetes 57 million with Prediabetes

3. What Are Our Chances of Developing Diabetes?  Lifetime – from birth till death o 33% (male), 39% (female)  Annual – adults o ~ 1%  Lifetime – from birth till death o 33% (male), 39% (female)  Annual – adults o ~ 1%

4. Intervention Time Window 3–6  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) 3–6  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)

5. 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)  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)

6. 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)  Pan et al. (1997)  Tuomilehto et al. (2001)  DPP Research Group (2002)***  Kosala et al. (2005)  Ramachandran et al (2006)

7. PlaceboMetforminLifestyle Annual Incidence of diabetes11.0%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 Effect of Treatment on Incidence of Diabetes in the DPP (All participants had IGT) The DPP Research Group, NEJM 346 :393-403, 2002

8. Intervention Impact by Ethnicity The DPP Research Group, NEJM 346 :393-403, 2002

9. 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

10. 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 t he wt. loss  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 t he wt. loss

11. 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. 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.

12. 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 (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

13. 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 (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

14. Prevention of Type 2 Diabetes The Community – Clinic Partnership Model CommunityClinic Total Population Pre-diabetesDiabetes Complications Informed Population Strong Community Organizations Partnership Zone Information Systems Decision Support Proactive Practice Team Screening for High Risk Diagnosis of Pre-diabetes Structured Lifestyle Programs Regular Glucose Monitoring Insurers Employers Reimbursement } Healthy Public Policy Supportive Environments Informed, Activated Patient s

15. 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)