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					SDPI Healthy Heart Project                        GLOSSARY                    Page 1 of 20


SDPI Diabetes Prevention Program and Healthy Heart Project
                       GLOSSARY

This glossary will serve grantees and CC staff as a “dictionary” of terms used in SDPI
Demonstration Projects’ forms and questionnaires, Operations Manual, Semi-Annual
Progress Reports, Core Elements and clinical protocols, and general program
information. While each form will have a set of item-by-item directions, we anticipate
that grantees will need to look up specific terms from time to time. Some glossary
entries define terms, while others translate commonly used acronyms.

Please note: This glossary is a work in progress. We anticipate adding to it as grantees
make suggestions of terms to be added, and as new phases of the projects develop.

A1c
An abbreviation for glycosylated hemoglobin A1c (also called HbA1c), an alternate
marker for blood glucose levels. An A1c test measures how much glucose has been
sticking to hemoglobin during the past 3-4 months. Hemoglobin is the protein on the
outside of red blood cells that carries oxygen to the cells of the body. The A1c test is
important in diabetes as a long-term measure of control over blood glucose. Even
outside of diabetes, an elevated A1c level may be a cardiovascular risk factor.

AACE/A1
Annual Assessment of Core Elements form. This form is completed by grantee staff
within 1 month after the yearly anniversary of the participant’s first intensive activity, and
includes clinical and laboratory values and body measurements. This form applies only
to transition participants.

A/C Ratio
Urine albumin-to-creatinine ratio. This is a laboratory test on a spot urine (a urine
sample without rigid restrictions on time of day, whether or not fasting, etc.) in which the
concentrations of albumin (a protein) and creatinine are each measured and the
albumin concentration is divided by the creatinine concentration. A higher than normal
level of albumin in the urine may indicate albuminuria, a condition that may be a sign of
kidney or cardiovascular disease.

Accrual
The cumulative number of participants who have begun the project to date. In this
project, a participant is counted in the accrual number when his/her Baseline
Assessment of Core Elements (BACE/B1) or baseline Comprehensive Assessment
form (C1) form is submitted to the Coordinating Center.




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ACE Inhibitor
Angiotensin-converting enzyme inhibitors are a group of medications that are used
primarily in the treatment of hypertension (high blood pressure) and congestive heart
failure, in some cases as the drugs of first choice. They are also used as a preventive
measure in people at high risk for kidney disease and cardiovascular disease, such as
people with diabetes.

Active
Refers to an individual who is participating in the DP Program or HH Project at any
level.

ADA
American Diabetes Association

Adverse Drug Reaction (ADR)
An adverse reaction is an expression that describes harm associated with the use of
given medications at a normal dose. The meaning of this expression differs from the
meaning of "side effect", as this last expression might also imply that the effects can be
beneficial.

Adverse Event
An adverse event is defined as an event reported by or happening to a participant that
occurs more frequently or with greater severity than would normally be expected and
that places her/him at increased risk.

AIANs
American Indian and Alaska Natives

Albumin
Refers generally to any protein found in human tissues and blood with water solubility
Albumins moderately soluble in concentrated salt solutions, and experiences heat
coagulation (protein denaturation.). The most well-known type of albumin is serum
albumin. It is most common in the blood or serum (providing its name) but it can also
appear in other bodily fluids. Serum albumin is the most abundant blood plasma protein
and is produced in the liver and forms a large proportion of all plasma protein. Serum
albumin normally constitutes about 60% of human plasma protein. Elevated levels of
albumin can indicate a problem with the filtering system of the kidneys.

Anticoagulant Therapy
The therapeutic use of anticoagulants is to discourage the formation of blood clots. Its
main purpose is to prevent clots from forming or re-forming. The chemical action of an
anticoagulant can destroy a clot and thereby improve the amount of oxygen supplied to
the tissue or organ affected by an occluded vessel. Conditions in which this therapy is
used include occlusive vascular disease, such as coronary artery occlusion (aka heart
attack), cerebrovascular artery occlusion (aka stroke), deep vein thrombosis (aka DVT)
and pulmonary embolism.


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Antihypertensive medication
Medication that helps lower blood pressure.

Antiplatelet Therapy
The use of medications that work by preventing platelets from sticking to blood vessel
walls and each other. This action will prevent blood clots that occur in arteries and
veins and thus can minimize the risk of atherosclerotic plaque development in the heart
and brain. Use of antiplatelet therapy is also used to prevent blood clots in the
extremities.

ARB
Angiotensin II receptor blockers are a class of medications used to treat hypertension.
They work by altering the renin-angiotensin-aldosterone system in the kidney by
inhibiting a substance that causes blood vessels to narrow (constrict). As a result, blood
vessels relax and widen (dilate), making it easier for blood to flow through the vessels,
which reduces blood pressure. These medicines also increase the release of water and
salt (sodium) to the urine, which in turn lowers blood pressure as well. This class of
medication is also used to treat diabetic nephropathy (kidney damage due to diabetes)
and congestive heart failure.

Aspirin Therapy
Atherosclerosis (plaque formation in arteries) and vascular thrombosis (clot formation)
are major contributors to cardiovascular disease, and it is generally accepted that
platelets are a significant contributing factor. Studies have shown that platelets from
men and women with diabetes are often more sensitive to agents produced by the body
that cause platelets to clump together (platelet aggregation). A major mechanism is
increased production of thromboxane, a potent blood vessel constrictor and platelet
aggregant. Investigators have found evidence that individuals with type 2 diabetes with
cardiovascular disease release excess thromboxane. Aspirin blocks thromboxane
synthesis and has been used as a primary and secondary strategy to prevent
cardiovascular events in non-diabetic and diabetic individuals.

Attrition
A reduction in the number of participants. In this project, attrition means losing program
participants, or the number of participants that have dropped out of the program (for
whatever reason). (Attrition of staff members may also occur).

Baseline
Term used to identify a set of measures taken at the beginning of a study or project, just
before the participant starts to receive any of the project intervention (treatment or
education). These first measures then serve as the reference point against which the
outcomes measures (the measures taken after the activities are completed) are
compared. It is very common for public health programs to collect baseline
measurements to be able to evaluate whether participation in the project has resulted in
the desired change in the health status of the participant. Individuals’ health status can
change quickly, so it is very important that we know the health status of the participant


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just before s/he receives any intensive activities, and can then compare it to the same
measures of health status taken after the participant completes the intensive activities.

Body Mass Index (BMI)
A measure of body weight relative to height. BMI can be used to determine if a person
is underweight, normal weight, overweight, or obese. You calculate BMI with weight and
height measurements according to a formula. An online calculator is available at:
http://www.cdc.gov/nccdphp/dnpa/bmi/calc-bmi.htm.

BP
Blood pressure

C1
Comprehensive Assessment Form. This form is completed by grantee staff at baseline,
within a month after the last DPP class (DP Program only), and within 1 month after the
yearly anniversary of the participant’s first intensive activity, and includes clinical
measurements, laboratory values, clinical history, and medications.

C2
Comprehensive Participant Questionnaire. This questionnaire is completed by the
participant before beginning intensive activities, within a month after the last DPP class
(DP Program only), and within 1 month after the yearly anniversary of the participant’s
first intensive activity, and includes information on participants’ behaviors and
comorbidities.

Cardiac Clearance
A specific medical evaluation of the heart’s functioning that is based on ECG results, an
individual's medical history, age and risk factors, and sometimes other procedures, to
determine if the individual's heart is healthy enough to allow beginning an exercise
program without significant risk of a cardiovascular event (heart attack, stroke, etc.).
Based on clinical recommendations, the evaluation may include additional tests such as
a stress test. A cardiac clearance may also include recommendations for appropriate
level of physical activity for that individual. (See Glossary Addendum for clarification of
difference between Cardiac Clearance, ECG, Stress Test, and Physical Exam).

Cardiovascular Disease (CVD)
In the SDPI Demonstration Projects, cardiovascular disease is defined as coronary
artery disease, cerebral vascular disease, peripheral vascular disease, and aortic
disease.

Casual Sugar
See the definition of Random Plasma GlucoseTest.

CBA
Community-Based Activity is a function or activity that takes place in a community
served by a demonstration project. Community-based activities can be used to screen


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for potential participants or as a retention tool. Some examples are health fairs, fun
runs, gathering and cooking traditional foods, and games (softball, stick ball, volleyball).

CC
Abbreviation for the IHS SDPI Demonstration Projects Coordinating Center

CGP
Competitive Grant Program. Former name of the Special Diabetes Program for Indians
Demonstration Projects.

CM
Case Management.generally refers to the planning and coordination of health care
services appropriate to achieve the goal of improved medical care and health. Medical
case management may include, but is not limited to, care assessment, including
personal interview with the patient, and assistance in developing, implementing and
coordinating a medical care plan with healthcare providers, as well as the patient and
his/her family and evaluation of treatment results. In terms of the Healthy Heart (HH)
Project it is a clinic and team-based approach that includes monthly in-person visits for
participants at which they receive individual case management, disease management,
and self-management education.

CMO
Chief Medical Officer

COMIRB
Colorado Multiple Institutional Review Board is a consortium of health care facilities in
Colorado comprised of the following: University of Colorado Denver Anschutz Medical
Campus, Colorado Prevention Center, Denver Health Medical Center. Its purpose is to
review biomedical and behavioral research involving human subjects conducted at or
supported by each of the member institutions to ensure participant safety and
confidentiality.

Community
For the purposes of the demonstration projects, this term refers to the people that live in
the same locality that the demonstration projects serve. It also implies a distinct
segment of society with common values and practices.

Comorbidity
The coexistence of two or more pathologies, or disease processes, in the same
individual.

Consortium
A group of organizations formed to undertake an activity that would be beyond the
capabilities of the individual members. For the purposes of this project, a consortium is
a group of entities, each meeting all requirements of the SDPI Demonstration Projects
except that their individual diabetes registries are below the required 250 individuals


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and/or their user populations are under 2500. The consortium as a whole is expected to
meet recruitment goals.

Coordinating Center (CC)
The SDPI Demonstration Projects Coordinating Center (CC) is located at the University
of Colorado Denver Anschutz Medical Campus. The Coordinating Center is responsible
for the coordination of data collection, entry, analysis, and reporting, communications
between the IHS Division of Diabetes and Prevention (DDTP) and the grantees, and
providing programmatic and data collection technical assistance.

Creatinine
Creatinine is a by-product of muscle metabolism excreted by the kidneys. Elevated
levels can indicate kidney disease or urinary tract obstruction.

CVD
Cardiovascular Disease

DDTP
Division of Diabetes Treatment and Prevention (of the Indian Health Service). Formerly
called the National Diabetes Program (NDP).

DGO
Division of Grant Operations of the Indian Health Service.

Diabetes
Diabetes is a disease in which the body does not produce or properly use insulin.
Insulin is a hormone that is needed to convert sugar, starches, and other foods into
energy needed for daily life. In the SDPI Demonstration Projects, diabetes refers to type
2 diabetes.

Diabetes Prevention Program (DP)
The Diabetes Prevention Program is one of the two projects that make up the IHS SDPI
Demonstration Projects initiative. In order to differentiate this from the original NIH-
funded DPP research study, we use only the first 2 letters. Also referred to as the DP
Program.

Diabetes Prevention Program (DPP) (Original)
The DPP was a major research study funded by the NIH aimed at discovering whether
either diet and exercise or the diabetes drug Metformin could prevent or delay the onset
of Type 2 diabetes in people with impaired glucose tolerance. The intensive activities in
the DP program are based on the activities in this research study.

Diabetic
This term is usually used to describe someone with diabetes or to refer to something
related to diabetes. In general, diabetes educators do not like to use this term since it
labels an individual. Therefore, we identify “individuals with diabetes”, not as “diabetic”.


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Diagnosis
This term refers to the decision of a physician or other health provider to say that
someone definitely has a certain health condition, such as diabetes. Often, diagnosis
must be made from parts of a physical exam, history, and laboratory tests and/or x-rays.

Dipstick
A testing dipstick is usually made of paper or cardboard and is impregnated with
reagents that indicate some feature of the liquid by changing color. Medical dipsticks
can be used to test a variety of liquids for the presence of a given substance, known as
an analyte. In blood glucose testing, the analyte is glucose. Dipsticks used in urine
albumin testing may test for albumin, protein, creatinine, or a combination of the three.

DM
An abbreviation for diabetes mellitus. See the definition of Diabetes.

DP Program
Abbreviation for the IHS SDPI Diabetes Prevention Program.

DPP Class, or DPP Curriculum Class
One of 16 weekly classes which comprise an educational curriculum of healthy
behaviors and skill-building to prevent diabetes, originally developed by the NIH DPP
research study and now used in the SDPI Diabetes Prevention Program.

ECG (Electrocardiogram)
The ECG is a test that provides a printed tracing of electrical activity in the heart. ECGs
are used for screening purposes (for the SDPI Demonstration Projects) or for diagnostic
purposes (for patients presenting with possible heart-related physical symptoms). See
Glossary Addendum for clarification of difference between Cardiac Clearance, ECG,
Stress Test, and Physical Exam.

Error Notification Letter (ENL)
An e-mail letter from the Coordinating Center to individual grantee sites that includes all
or some of the following: comments about particular submissions, a list of participant
forms with errors identified at submission, a list of participants whose date of starting the
intensive activities was not submitted to the Coordinating Center, a list of participants
whose assessment forms are missing data, have out-of-range data, dates that need to
be verified or other data issues, and a list of participants whose forms are overdue.
ENLs are generated at the end of each month.

Excel Registry
The Excel Registry is an Excel spreadsheet that was developed by the Coordinating
Center for grantees to record information on the recruitment and screening of
individuals, in which grantees keep a cumulative list of potential participants, their


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screening data, and their responses to recruitment efforts. The Excel Registry assigns
an incremental Participant ID number as potential participants are added to the
Registry.

Exclusion Criteria
Personal characteristics that make the potential participant ineligible for the programs
(i.e., they cannot participate). Some of these are the same across DP and HH:
    o Less than 18 years of age
    o Current diagnosis of pregnancy
    o Active alcohol or substance abuse by provider judgment that would affect
         successful participation
    o End Stage Renal Disease on dialysis
    o Current diagnosis of cancer undergoing treatment that prohibits participation by
         provider judgment
    o Any other significant or unusual condition or life situation that makes it likely that
         the participant will not be able to participate

       Specific to HH:
     o Prior CVD is not an exclusion unless the individual currently has medically
       unstable CVD by provider judgment

FACE/F1
Follow-Up Assessment of Core Elements form. This form is completed by grantee staff
after a participant completes the 16-session DPP curriculum classes (DP program only).
This form applies only to transition participants.

FBG - Fasting Blood Glucose Test
This test measures blood glucose levels after a minimum of 8 hours of fasting. It is used
to detect diabetes or prediabetes. The test is usually done in a lab in the clinic.

Follow-up
In general, the term follow-up refers to gathering of data from outcomes measured after
(or during) an intervention (DPP curriculum classes or Case Management visits). In the
DP Program, Follow-up refers specifically to the assessment and questionnaire
administered immediately after the participant has completed the 16-session DPP
curriculum. This applies only to transition participants.

FY
Fiscal Year. A twelve month period for which an organization plans the use of its funds.
The Indian Health Service (IHS) fiscal year is October through September.

Gluconeogenesis
Formation of glucose from protein within the liver.

Glucose Metabolism
How glucose (blood sugar) is processed by the body.


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Glycemic Measure
A term that refers to a test or measurement of glucose in the blood.

Grantee ID
In this project, Grantee ID refers to a randomly generated confidential ID number which
was assigned to each grant program for use in identifying their data in reports from the
CC.

Grantee-Level Forms
Grantee-level forms refer to forms that document the characteristics or activities of the
individual grant programs. For example, the DP Team Meetings Form, the Case
Management Team Meetings Form, and the Recruitment Activities Report are examples
of grantee-level forms.

HbA1c
An abbreviation for glycosylated hemoglobin A1c. See definition for A1c.

HDL (High Density Lipoprotein) Cholesterol
A fat found in the blood that takes extra cholesterol from the blood to the liver for
removal. Also known as “good” cholesterol.

Healthy Foods
For the purposes of data analysis of certain diet questions on this project, healthy foods
are considered to be whole grain bread, fruit, lettuce or green leafy salad, cooked dried
beans, fish/chicken/game, and vegetables.

Healthy Heart Project (HH)
The name given to the CVD risk reduction project, also referred to as the HH Project,
one of the two projects that make up the IHS SDPI Demonstration Projects initiative. .

Hemoglobin
The part of a red blood cell that carries oxygen to the cells and sometimes joins with
glucose in the bloodstream.

HGHH (Honoring the Gift of Heart Health)
A comprehensive, culturally appropriate, user-friendly 10 lesson course on heart-health
education for the American Indian community, developed by the National Heart, Lung
and Blood Institute of the National Institutes of Health and recommended for use in the
Healthy Heart Project.

HH Project
Abbreviation for the IHS SDPI Healthy Heart Project.




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HIPAA
Health Insurance Portability and Accountability Act of 1996. This act set standards for
the use and disclosure of individuals’ protected health information (PHI). HIPAA was
designed to protect privacy rights while also establishing guidelines for the sharing of
information within the healthcare network. HIPAA Authorization A allows health
programs to share patient PHI with other programs (for recruitment). The IHS National
IRB has approved the SDPI Demonstration Projects to conduct recruitment activities
without individual participant consent (HIPAA Authorization A). HIPAA Authorization B is
signed by a participant at enrollment so that the health program can share the
participant’s PHI with other entities (such as the Coordinating Center). The PHI sent to
the Coordinating Center will be very minimal, including age, tribal affiliation, and dates
of specific laboratory tests. No names will be sent to the Coordinating Center.

HQE
Headquarters East of the Indian Health Service

Hyperglycemia
High blood glucose levels caused by either low insulin production or insulin resistance.
The classic symptoms of hyperglycemia include increased hunger, thirst, and frequent
urination.

Hypertension
This term refers to a diagnosis of high blood pressure, which can cause an increased
risk for cardiovascular disease.

IFG - Impaired Fasting Glucose
A form of prediabetes where fasting glucose levels are higher than normal but not high
enough to be called diabetes. Individuals with IFG are at risk of developing diabetes but
do not have it yet. Fasting glucose levels between 100 and 125 mg/dL indicate Impaired
Fasting Glucose. The only way to diagnose IFG is to measure blood glucose while
fasting.

IGT - Impaired Glucose Tolerance
A form of prediabetes where blood glucose levels are higher than normal but not high
enough to be called diabetes. Individuals with IGT are at risk of developing diabetes but
do not have it yet. The only way to diagnose IGT is through a 2-hour Oral Glucose
Tolerance Test (OGTT). Blood glucose levels at the 2-hour time between 140 and 199
mg/dL indicate Impaired Glucose Tolerance.

IHS
Indian Health Service. The Indian Health Service (IHS), an agency within the
Department of Health and Human Services, is responsible for providing federal health
services to American Indians and Alaska Natives. The IHS is the principal federal health
care provider and health advocate for Indian people, and its goal is to raise their health
status to the highest possible level.



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Inactive
Refers to an individual who is unable or unwilling to continue participation (activities or
assessments) in the DP Program or HH Project. Inclusion criteria
These define who can be invited to participate in the programs (if they do not meet any
of the exclusion criteria).

For the DP Program, the Primary inclusion criterion is a diagnosis of prediabetes. The
Alternative inclusion criterion is Metabolic Syndrome without diabetes. In any given
year, each program may enroll no more than 10 participants based on the eligibility
criteria for Metabolic Syndrome.

For the HH Project, the Primary inclusion criterion is a diagnosis of diabetes. The
Alternative inclusion criterion is Metabolic Syndrome without prediabetes. In any given
year, each program may enroll no more than 10 participants based on the eligibility
criteria for Metabolic Syndrome.

Insulin Resistance
Insulin resistance occurs when the body doesn’t respond appropriately to the insulin
that the pancreas is making and glucose is less able to enter the cells. People with
insulin resistance may or may not develop Type 2 diabetes. Insulin resistance also may
be linked to obesity, hypertension and high levels of fat in the blood.

Interquartile Range
In data reporting, the Interquartile Range is the distance between the 25th and the 75th
percentiles.

Intervention
The creation of a well-planned, structured process by which an identified crisis or
problem is addressed. In the context of public health programs, the term intervention
usually refers to the activities that the program implements to improve a particular
health issue.

IRB
Institutional Review Board. A committee that has been formally designated to approve,
monitor, and review biomedical and behavioral research involving human subjects with
the aim to protect the rights and welfare of the research subjects.

IT
Information Technology is the development, installation, and implementation of
computer systems and applications.

LDL (Low Density Lipoprotein) Cholesterol
A fat found in the blood that carries cholesterol to areas of the body where it is needed
for cell repair. LDLs also deposit cholesterol on the inside of artery walls. LDL is
sometimes called “bad” cholesterol.


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Lipid Lowering Agents (LLA)
A diverse group of medications that are used in the treatment of high lipid levels in the
blood. They are also called lipid-lowering drugs (LLD).

Lipids
The term lipids usually refers to certain fats found in the body. The lipids measured in
the SDPI Demonstration Projects are LDL, HDL, triglycerides, and total cholesterol.

M1 (Mid-Year) Form
The Mid-Year (M1) form reports a glycemic measure result on each DP participant 6
months after each annual assessment.

Mean
In data reporting, the Mean is the average of n numbers computed by adding all of the
numbers and dividing by n.

Median
In data reporting, the Median is the value below which 50% of the people (or cases) fall.

Metabolic Syndrome
The tendency of several conditions to occur together, including obesity, insulin
resistance, diabetes or prediabetes, hypertension, and high lipids. Not all people with
Metabolic Syndrome have prediabetes or diabetes, and not all people with prediabetes
or diabetes have Metabolic Syndrome. People with Metabolic Syndrome are at risk for
developing diabetes (or prediabetes) and cardiovascular disease. In this project, to be
diagnosed with Metabolic Syndrome, an individual must have three or more of the
following five conditions:
     Abdominal Obesity (waist circumference > 40 inches (or 102 centimeters) for
       men, or > 35 inches (or 88 centimeters) for women).
     Hypertension (Blood pressure ≥ 130/85 mm Hg) or on drug treatment for
       hypertension
     Low HDL Cholesterol (< 40 mg/dl in men, < 50 mg/dl in women) or on drug
       treatment for low HDL
     High triglycerides (≥ 150 mg/dl) or on drug treatment for high triglycerides
     Elevated fasting plasma glucose (FBG ≥ 100 mg/dl)

Metformin
An oral medicine used to treat Type 2 diabetes. It lowers blood glucose by reducing the
amount of glucose produced by the liver and helping the body respond better to insulin
produced by the pancreas.

Microalbumin
Small amounts of the protein albumin in the urine detectable with a special lab test.


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Missing Data
In this project, missing data refers to required fields in a form or questionnaire for which
a value has not been entered. On the assessment forms, this includes measurements,
dates of measurements, and medications. On the questionnaires, missing data refers
only to the required fields on the first page, which include the grantee NDPID #, Site ID,
Participant ID, timing of the assessment, and date the questionnaire was completed.
Since participants have the option to skip individual questions, any other questions, if
left unanswered, are not considered missing data.

NCNHB
Nighthorse Campbell Native Health Building. The building that houses the SDPI
Demonstration Projects Coordinating Center on the University of Colorado Denver
Anschutz Medical Campus.

NDP
National Diabetes Program. Former name of the IHS Division of Diabetes Treatment
and Prevention (DDTP).

NDPID Grantee #
A 5-digit number assigned to each grantee at the beginning of the project. These
numbers are listed in Appendix C.

New Participant
Refers to a participant whose baseline assessment was completed on or after 8/1/2009.

NHLBI
National Heart, Lung, and Blood Institute of the National Institutes of Health.

Non-response
In this project, if a participant refuses to provide certain information asked in the
participant questionnaire, it is called a non-response.

Oral Glucose Tolerance Test (OGTT)
This test measures blood glucose levels after a minimum of 8 hours of fasting, and 2
hours after consuming a glucose-rich beverage. It is used to diagnose diabetes or
prediabetes.

Organization ID #
ID number assigned to the staff member of the organization asked to complete the
Organization Annual Questionnaire.




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Original Participant
Refers to a participant whose Year 1 annual assessment was due on or before
7/31/2009.

Outcome Evaluation (what was the result/outcome of what we did?)
This type of evaluation assesses the outcomes or results of a program. An outcome
evaluation gauges whether the program/intervention worked, how well it worked, and for
whom it worked.

P1 (Participant Attendance Form)
The P1 form is used to record each participant’s attendance at DPP classes, monthly
coaching visits, and other Diabetes Prevention Program activities for the Diabetes
Prevention Program and at case management visits and other Healthy Heart Project
activities for the Healthy Heart Project.

P2 (Participant Retention Form)
The P2 form is used to inform the Coordinating Center when a participant changes from
active to inactive status or from inactive to active status.

PAQ/A2
Participant Annual Questionnaire. This questionnaire is completed by the participant at
the yearly anniversary of the participant’s first intensive activity, and includes
information about the participant’s health, life, family, and community. This
questionnaire applies only to transition participants.

Participant
This term refers to a person who has agreed to be in the program and has completed a
baseline assessment.

Participant ID #
A 4-digit number assigned whenever a potential participant is entered into the Excel
Registry. Some potential participants will not go on to become actual participants, but
they will keep their assigned Participant ID#.

Payment Management System (PMS)
The Payment Management System is the name of the computer system used by the
U.S. Department of Health and Human Services (HHS) to disburse monthly payments
to recipients of grant awards.

Percentile
In data reporting, the pth percentile of a list of numbers is the number such that p
percent of the numbers in the list are less than that number. For example, if a student
scores in the 75th percentile on a standardized test, then 75% of those taking the test
had lower scores.




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PFQ/F2
Participant Follow-Up Questionnaire. This questionnaire is completed by the participant
after completing the 16-session DPP curriculum classes (DP Program only). This
questionnaire applies only to transition participants.

PHI
Protected Health Information (also see HIPAA). Under the U.S. Health Insurance
Portability and Accountability Act (HIPAA), PHI is any information about health status,
provision of health care, or payment for health care that can be linked to an individual.
Examples include names, geographical subdivisions smaller than a State, dates, phone
numbers, etc.

Physical Exam (for SDPI Demonstration Projects purposes)
The Physical Exam must be conducted by a licensed medical provider (physician, nurse
practitioner, physician assistant working with MD). For the purposes of the SDPI
Demonstration Projects, the provider’s task is to identify health issues that may impact
an individual’s ability to successfully participate in the intensive activities of the program.
The PE is a medical evaluation consisting of examinations of the participant’s health
systems (particularly cardiovascular, respiratory, musculoskeletal), as well as a review
of the individual’s medical history, baseline lab results, and ECG. Based on the ECG
results or other factors, the provider may also choose to conduct a cardiac clearance.
See Glossary Addendum for clarification of difference between Cardiac Clearance,
ECG, Stress Test, and Physical Exam.

Polycystic Ovarian Syndrome (or Polycystic Ovary Syndrome)
A complex of symptoms characterized by cysts in the ovaries, absent or irregular
periods, infertility, and excess androgen production. This medical condition carries an
increased risk of diabetes. In the SDPI Demonstration Projects, female participants are
asked if they have a history of Polycystic Ovarian Syndrome.

Polypharmacy
Meaning “many drugs”, polypharmacy occurs when prescribed medications duplicate or
interact with each other, often with negative or life-threatening consequences.

Post-DPP Class
Refers to the assessment and questionnaire administered immediately after the
participant has completed the 16-session DPP curriculum class.

Prediabetes
Lay term that is used to describe individuals who are at very high risk for diabetes.
Clinically speaking, this term is used to classify people with blood glucose levels that
are higher than normal, but not yet in the diabetic range.




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SDPI Healthy Heart Project                         GLOSSARY                    Page 16 of 20


Prevention
In the SPDI Demonstration Projects, the term prevention refers to trying to stop a
medical condition from occurring in those at risk, i.e., prevention of diabetes in people
with prediabetes or prevention of CVD in people with diabetes.

Proteinuria
The presence of an excess of serum proteins in the urine. Proteinuria may be a sign of
renal (kidney) damage.

Protocol
A detailed plan and established procedures for a medical or public health intervention.

Random Plasma Glucose Test
Also known as Casual Sugar. This test, in combination with an assessment of
symptoms, may be used to diagnose diabetes. This test is normally run in a medical lab
without regard to time of last food or calorie intake. In the SDPI Demonstration
Projects, per IHS Standards of Care, a random plasma glucose test may not be used
singularly to diagnose prediabetes or diabetes.

Recruitment
The process of adding new individuals to a program, organization, or population, and
the strategies used to secure participants.

Retention
The process of retaining individual participants in a program or organization; i.e,
activities that encourage/motivate the participant to continue to participate in the
program or organization.

RFA
Request for Application (sent out by a funding agency). Sometimes also called an RFP
(Request for Proposal).

RPMS
Resource and Patient Management System. The primary database system for collecting
and managing patient, clinical and administrative data in IHS facilities.

Scale
In data reporting, a Scale summarizes the answers to a set of questions which are
designed to measure a specific aspect of a person’s behavioral or psychosocial
characteristics.

Screening
Activities that identify individuals who are at risk for a disease or condition. If the screen
is positive, then the person needs to have further testing to make the diagnosis.




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SDPI Healthy Heart Project                      GLOSSARY                   Page 17 of 20


SDPI
Special Diabetes Program for Indians. A $150 million per year grant program that
provides funding for diabetes treatment and prevention services at 399 IHS, Tribal, and
Urban Indian health programs in all 12 IHS Areas across the United States. The SDPI
grant programs use proven, evidence-based, and community-driven diabetes treatment
and prevention strategies that address each stage of the disease.

Site #
Grantees with more than one data collection site have been assigned a number for
each site. Those with only one site will use “1”.

Standard Deviation (SD)
In data reporting, standard deviation is a measure of the spread or dispersion of a set of
data. The more widely the values are spread out, the larger the standard deviation. For
example, say we have two separate lists of exam results from a class of 30 students;
one ranges from 31% to 98%, the other from 82% to 93%, then the standard deviation
would be larger for the results of the first exam.

Statin
Refers to a class of drugs used to lower plasma lipid levels.

Steering Committee
The SDPI Demonstration Projects Steering Committee was formed to provide guidance
and recommendations regarding such matters as local variation in intervention
methods, successful project implementation, and appropriate evaluation measurements.

Stress Test
Sometimes also called a treadmill test or exercise test. This test measures the heart’s
ability to work when “stressed” by low, medium, and high intensity exercise, and helps
the provider determine the kind and level of exercise appropriate for that individual. An
abnormal Stress Test may indicate a need for additional tests. Cardiologists and other
physicians with special training can perform this test with proper equipment. (See
Glossary Addendum for clarification of difference between Cardiac Clearance, ECG,
Stress Test, and Physical Exam).

Strong Heart Study
A longitudinal cohort study of the risk factors for cardiovascular disease in American
Indians funded by the National Heart, Lung, and Blood Institute, National Institutes of
Health. This project demonstrated that diabetes is a major risk factor and accounts for
the majority of risk for cardiovascular disease events in American Indians.

TA
Technical Assistance




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SDPI Healthy Heart Project                       GLOSSARY                   Page 18 of 20


Timeline Compliance
Timeline Compliance refers to whether evaluation measurements were obtained at the
proper time in relation to the intervention, i.e., whether each clinical measure and
questionnaire was collected within the required time period before, during, or after
project intervention activities. The Timeline Requirements (see below) clarify the time
period during which each measurement must be collected to ensure accuracy of the
baseline and follow-up results. In this project, Timeline Compliance is based only on the
expected timelines, not the exceptions.

Timeline Requirements
Clinical and body measurements and questionnaires must be collected on a specific
timeline in relation to the start and end of intervention activities of the project. For
example, in the SDPI Demonstration Projects (as with most program evaluations) all
baseline measurements need to be obtained just before the start of the intervention,
specifically within one month before the start of the intensive activities. For a few
measures, this timeline is wider (for instance, lipids measures may be collected up to
three months prior to the start of intensive activities).

Title V
A section of the Indian Health Care Improvement Act which established a discrete
program for urban Indians. The first direct Indian Health Service funding for Title V
programs came in 1979.

TLDC
Tribal Leaders Diabetes Committee. A committee that makes recommendations to the
IHS Director on broad-based policy and advocacy priorities for diabetes and related
chronic conditions.

Transition Participant
Refers to a participant whose baseline assessment was completed prior to 8/1/2009
with the first annual assessment due after 7/31/2009.

Transition Year
Refers to the period of time from 8/1/2009 to approximately 7/31/2010 during which
grantees transition from using the Original data collection forms to using the New data
collection forms.

Triglycerides (TG)
Triglycerides are the chemical form in which most fat exists in food as well as in the
body. High triglyceride levels may occur when diabetes is out of control.

Type 2 diabetes
Sometimes referred to as type II diabetes, type 2 diabetes results from insulin
resistance (a condition in which the body fails to properly use insulin), sometimes
combined with relative insulin deficiency. Most Americans who are diagnosed with



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SDPI Healthy Heart Project                      GLOSSARY                  Page 19 of 20


diabetes have type 2 diabetes. In the past, type 2 diabetes was sometimes called non-
insulin dependent diabetes mellitus (NIDDM) or adult onset diabetes (AODM).

UCD
University of Colorado Denver. Previously called UCDHSC, University of Colorado at
Denver and Health Sciences Center. Home of the SDPI Demonstration Projects
Coordinating Center.

Unhealthy Foods
For the purposes of data analysis of certain diet questions on this project, unhealthy
foods are considered to be: bacon or sausage, processed meats, bread from processed
flour, frybread, other baked goods, regular soft drinks/soda, 100% fruit juice, adding
sugar or cream to coffee or tea, regular fat salad dressing or mayonnaise, french
fries/fried potatoes/tater tots/hash brown potatoes, “red” meat, fast food.

Unresolved Missing Data
In this project, unresolved missing data refers to required data in a form for which no
value has later been provided, after the CC has requested clarification from the grantee.

Urine AlbuminTesting
Refers to any medical test that measures albumin in the urine.




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SDPI Healthy Heart Project                         GLOSSARY                    Page 20 of 20


                                 Glossary Addendum
Difference between ECG, Cardiac Clearance, Stress Test, and Physical Exam


The Physical Exam (PE) must be conducted by a licensed medical provider (physician,
nurse practitioner, physician assistant with MD). For the purposes of the SDPI
Demonstration Projects, the provider’s task is to identify health issues that may impact
an individual’s ability to successfully participate in the intensive activities of the program.
The PE is a medical evaluation consisting of examinations of the participant’s health
systems (particularly cardiovascular, respiratory, musculoskeletal), as well as a review
of the individual’s medical history, baseline lab results, and ECG. Based on the ECG
results or other factors, the provider may also choose to conduct a cardiac clearance.

An ECG (electrocardiogram) is a test that provides a printed tracing of electrical activity
in the heart. ECGs are used for screening purposes (as for the SDPI Demonstration
projects) or for diagnostic purposes (for patients presenting with possible heart-related
physical symptoms). The ECG result is not by itself cardiac clearance. It is one element
of the cardiac clearance process.

Cardiac Clearance is a specific medical evaluation of the heart’s functioning that is
based on the ECG results, an individual's medical history, age and risk factors, and
sometimes other procedures, to determine if the individual's heart is healthy enough to
allow beginning an exercise program without significant risk of a cardiovascular event
(heart attack, stroke, etc.). Based on clinical recommendations, the evaluation may
include additional tests such as a stress test (see Appendix N5 for DP and Appendix N2
for HH). Cardiac clearance may also include recommendations for appropriate level of
physical activity for that individual. Note that the ECG result is NOT cardiac clearance.
It is one measure used to determine if the individual will receive cardiac clearance.

A Stress Test is sometimes also called a treadmill test or exercise test. It measures the
heart’s ability to work when “stressed” by low, medium, and high intensity exercise, and
helps the provider determine the kind and level of exercise appropriate for an individual.
An abnormal Stress Test may indicate a need for additional tests. Cardiologists and
other physicians with special training can perform this test with proper equipment. The
stress test result is not cardiac clearance. Like the ECG, it is one possible element of
the cardiac clearance process.

In other words:
The Physical Exam is the overall medical evaluation consisting of a variety of tests,
examinations, and analysis of history and risk factors. The ECG is one element of the
PE; cardiac clearance may be another element of the PE; a stress test may be one
element of the cardiac clearance process.




MAHHD Glossary
Last Revised: 8/9/2011

				
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