Dr Blonde began with a description on the National Diabetes Education Program (NDEP) and its activities. Although the initial focus was on diabetes control, the have also added a component focusing on the ABCs of diabetes (A1C, Blood pressure, and Cholesterol) for the prevention of macrovascular complication. Based on the success of the Diabetes Prevention Program (DPP), NDEP turned its focus to diabetes prevention with their Small Steps, Big Rewards campaign. NDEP has also developed materials for adolescents, their families, and schools on managing diabetes in children and adolescents.
A survey was conducted among people with diabetes, with prediabetes, and with people at high risk for diabetes. Of this sample, only 68% of patients with diabetes reported having had blood test in the last year. Similarly, 6% of patients with prediabetes and 51% of people at high risk reported having a blood test. In terms of awareness, only 57% of patients with prediabetes reported having heard the term prediabetes before, and only 47% of patients at risk had heard the term. Among people with diabetes, 78% reported being told to lose weight and 80% reported being told to increase physicial activity. However, only 54% and 67% of people with prediabetes were told to lose weight and increase physical activity, respectively, showing that the results of the DPP need to be better disseminated and translated. Perhaps most strikingly, only 59% of patients with prediabetes felt they were at risk for diabetes, and only 25% of people with an objectively high risk for diabetes perceived themselves to be at high risk. In short, there are still many opportunities to provide education to patients with or at risk for diabetes and their healthcare providers.
Griffin Rodgers, MD, Director of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) next discussed the major accomplishments of the NDEP, including commitment to basing work on science-based and evidence-based materials, noting that it is important for translating knowledge into action for both providers and patients. The NDEP is also committed to adapting materials for at-risk groups, especially high risk ethnic groups and elderly people. He also noted that NDEP has established numerous partnerships across the country and deep into the community to get their message across. A survey in 1997 revealed that only 8% of Americans believed that diabetes was important. A more recent survey conducted in 2003 showed that 89% felt diabetes was important. The results of these 2 surveys highlight the fact that the NDEP has made great strides on educating people on the importance of diabetes. The goal now is to educate people on how to prevent and manage diabetes.
David Marrero, PhD, JO Ritchey Chair of Medicine and Director of Diabetes Translation Research Center at the Indiana University School of Medicine next discussed the issue of translating the results of the DPP. One of the stunning aspects of the DPP was that it did not take an extraordinary amount of weight loss to reduce diabetes risk. Many people do not lose the amount of weight they would like and view themselves as failures. What they fail to appreciate is that health benefits can occur with modest weight loss. In the DPP there was a 58% reduction in risk of diabetes with lifestyle change and modest weight loss. Approximately 54 million US adults aged 20 and over have prediabetes, and people with prediabetes are at increased risk of diabetes and CVD. The goals of the Small Steps, Big Rewards campaign were to help prevent or delay diabetes among people with prediabetes, increase awareness of who is at risk for prediabetes, raise awareness of the term “prediabetes,� and help to educate healthcare providers on indications for testing for prediabetes. The NDEP created targeted materials for at-risk groups and their healthcare providers, as well as created practical strategies for the implementation of physical activity promotion and weight management. The materials included a brochure that discussed diabetes risk factors and how to address them, and incorporated strategies for food tracking to increase awareness of health behaviors.
The DEPLOY program (Diabetes Education and Prevention with a Lifestyle Intervention Offered at the YMCA) was created to determine if the DPP could be implemented in a group setting within the community. This study screened Y members to identify a population similar to that seen in the DPP. Participants were either provided brief risk factor counseling and given NDEP materials to implement their own change (control sites) or they participated in a group weight loss intervention group. Participants in the intervention group lost an average of 6.5% of their body weight, similar to the weight loss seen in the DPP. In the control condition, patients lost 2% of their body weight, suggesting that even a brief intervention can have some effects. In short, primary prevention is feasible in the community, may increase the likelihood of success if you make people aware of their risk.
Francine Kaufman, MD, Chair elect of NDEP and Director, Comprehensive Childhood Diabetes Center, Childrens Hospital Los Angeles discussed NDEP resources for children and adolescents. Close to 180,000 children in US have diabetes. Diabetes in children affects families, schools, and communities where these children live. Children with diabetes have to perform complex diabetes management activities, and they are out of the care of their parents for major parts of the day. Furthermore, a healthy lifestyle is critical to the success of diabetes self-management and prevention of complications among children with diabetes. Diabetes Prevention is challenging in the pediatric context. It is a complex issue to explain risk to children and family, and promoting lifestyle change involves the whole family.
Based on these needs the NDEP created materials for managing childhood diabetes. They developed materials for a variety of audiences, including children with diabetes, their families, healthcare providers, and school personnel. Materials focus on ensuring that children receive the proper support and care. They define roles and responsibilities for the child and important others in the life of the child. The materials also provide tools for diabetes management and an overview of federal laws. Materials for children are available in English and Spanish. Tip sheets are available for children and teens with diabetes, as well as for kids who are at risk for diabetes. Educational materials have also been created to highlight the importance of gestational diabetes with a focus on risk to the child. Specifically, an educational piece was created to discuss the importance of intrauterine diabetes exposure to the child and the need for this to be part of the medical history. There are also a variety of online resources available from NDEP.
Dr Kaufman also discussed the STOPP-T2D Studies to Treat Or Prevent Pediatric Type 2 Diabetes. The HEALTHY trial is focusing on diabetes prevention, and the TODAY trial is focusing on treatment. The HEALTHY trial is ongoing and is examining the effect of social marketing of a healthy lifestyle within the school setting. The TODAY trial, also ongoing, has shown that children with type 2 diabetes already are burdened with risk factors at study entry. The goal of this study is to determine if we have an approach that will allow for durable glycemic control.
Following Dr Kaufman, Kelly Moore, MD, Chair, NDEP American Indian/Alaskan Native (AI/AN) Workgroup discussed the Move It campaign to increase physical activity among AI/ANs. The program included messages for reducing risk and targeted an audience of 12-18 year-olds. The program launched in 2001. The goals of the research were to determine the extent of dissemination of materials, to examine recall and utilization of the materials, and to gather recommendations on how to improve materials from participants. In terms of recall and use of materials, 60% heard of campaign; 50% recalled receiving materials; 42% used materials; and 48% reported using other NDEP materials. The posters were the most popular component of the campaign. Interestingly, 55.8% of respondents indicated that they used the materials with existing activities, but 30% reported using the materials to developing new activities. Based on feedback, the Move It campaign was revised. Revisions included the development of more striking fact sheets designed to be distributed directly to students, posters that were able to be customized to include pictures of local students, and a template for local newsletter. The Move It Grant Program funded schools to implement activities related to the Move It campaign.
The next talk was given by James Gavin III, MD, PhD, from the Emory School of Medicine. He discussed how the NDEP has developed a strong focus on translating information. They are attempting to focus on how to promote change instead of what changes to make. They have done so through the use of multiple media, including television, radio, and print pieces. Most healthcare professionals are acutely aware that people with diabetes are not in good glycemic control. Although there is a need for better therapies, healthcare professionals are not using all of the tools effectively enough. The NDEP offers numerous educational materials for a wide variety of audiences, but it is important to examine systems of care. Many clinical settings cannot look across patient populations and identify individuals not meeting targets. Complications are treated reactively, not proactively, and many healthcare providers are still relying on an acute, rather than a chronic care model. Improving systems of care has been shown to improve outcomes. In one study, improvements in systems of care resulted in a 51% increase in the number of patients meeting glycemic targets. Additionally, 97.4% of patients with an A1C >8% had a prescription change. Improvements in blood pressure, lipids, and patient satisfaction were also noted. More information, as well as CME/CE opportunities related to systems change are available at: http://www.betterDiabetesCare.nih.gov. Information on bridging the gap between business and public health is available at http://www.diabetesatwork.org.
|
