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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