The Washington State Diabetes Connection by lifemate

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									         Diabetes Network Priorities
           Across the Spectrum of Diabetes

Shirley Broughton
Diabetes Network Leadership Team Member
Representing WSU Extension
HEALTHY
 YOUTH
           ADULTS
           NORMAL
          GLYCEMIA
                      ADULTS
                        PRE
                     DIABETES
                                 ADULTS
                                  UNDX
                                DIABETES

                                            ADULTS
                                              DX
                                           DIABETES
Session Goals
 Review the evidence
 Identify the Network priorities
 Report out to the larger group
Problem
Washington Adults:
 25% obese


   31% Prediabetes
   Prediabetes education is not a covered health
    benefit

   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
(not ITT).
• 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
groups.
• 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”
DPP Results
Evidence – The DPP
                                 16 sessions over 24
                                  weeks
Goals:
                                 Individual sessions
 7% weight loss/
                                 Professional
  maintenance                     staff/coaches
     25% calories from fat
                                 Reminder calls/visits
     1200-1800 calories
                                 Supervised activity
                                  sessions
   150 minutes / week           Incentives $100/per
    moderate activity             person/year
                                 Maintenance support
Evidence
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
    Educator 2009;35;309)

        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
    lifestyle modification
   Improved built environment
   Effective, affordable and sustainable lifestyle intervention
   Clinical services for PreDM
Choosing Priorities
 Needs to be evidence based
 Achievable within 2-5 years
 High level
 Consider current efforts
 Biggest Bang for the Buck
Questions to Answer for Each
Priority
 What is the summary of the evidence?
 What are the statewide priorities for the
  Network?
 How will these inform the work of Regional
  Coalitions?
 What priorities align with statewide
  integration efforts?

								
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