Diabetes Network Priorities
Across the Spectrum of Diabetes
Diabetes Network Leadership Team Member
Representing WSU Extension
Review the evidence
Identify the Network priorities
Report out to the larger group
Prediabetes education is not a covered health
12% Diabetes (diagnosed and undiagnosed)
Behavioral Risk Factor Surveillance System
Washington Adult Health Survey
Brief History of Primary Prevention RCTs
(DC Williamson 7/07)
• 1979, Jarrett et al., U.K: No effect of CHO-restricted diet or phenformin.
• 1980, Sartor et al., Sweden: Positive effect of diet counseling + tolbutamide
• 1982, Keen et al., U.K: No effect of diet or tolbutamide.
• 1993, Hansen et al., U.S.: Positive effect of diet in rhesus monkeys.
• 1997, Pan et al., China (6 yr): ~ ↓40%in diet, exercise and diet + exercise
• 2001, Tuomilehto et al., Finland (3 yr): ↓58%in diet + exercise group.
• 2002, DPP, U.S. (3 yr):
– ↓58%in diet + exercise group.
– ↓31% in metformin group.
• 2002, Chiasson et al., Canada, Israel, and 7 European countries (3 yr):
– ↓25%in acarbose group.
• 2006, Ramachandran et al., India (3 yr):
– ↓29%in diet+exercise group.
– ↓26%in metformin group.
– ↓28%in diet+exercise and metformin group.
• 2006, The DREAM Trial Investigators (3 yr – included persons with IFG):
– ↓60%in rosiglitazone group but 7-fold ↑in heart failure.
– No effect of ramipril.
NOTE: All studies were conducted in persons with
“impaired glucose tolerance”
Evidence – The DPP
16 sessions over 24
7% weight loss/
25% calories from fat
150 minutes / week Incentives $100/per
moderate activity person/year
Translating the DPP Questions???
• Cost - labor intensive
• Appropriate use of clinical sector
• Risk identification / stratification
-What about screening?
• Retention of participants
Translating the DPP into Practice
A Review of Community Interventions (Jackson, L Diabetes
Seven Studies - Applied DPP; Community Setting; DPP Goals
Significant results across DPP outcomes- effective for treating
overweight as risk factor.
Montana Cardiovascular Disease and Diabetes
Prevention Program (Amundson et al Diabetes Educator 2009;35; 209)
4 health care facilities implemented DPP
Significant results DPP outcomes – Weight and Activity
Evidence – other considerations
Increase knowledge and awareness for those at high risk
Improved health supporting norms and values
Enhanced linkages to screening and diagnostic testing
for Pre DM
Increased family, organizational and social supports for
Improved built environment
Effective, affordable and sustainable lifestyle intervention
Clinical services for PreDM
Needs to be evidence based
Achievable within 2-5 years
Consider current efforts
Biggest Bang for the Buck
Questions to Answer for Each
What is the summary of the evidence?
What are the statewide priorities for the
How will these inform the work of Regional
What priorities align with statewide