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The findings and conclusions in this presentation are those of the author and do not necessarily represent the views of the CDC.
Diabetes: Taming a Spreading DiseaseDiabetes: Taming a Spreading Disease
Ann Albright, PhD, RDAnn Albright, PhD, RDDirector, Division of Diabetes Translation
Centers for Disease Control and PreventionDirector, Division of Diabetes Translation
Centers for Disease Control and Prevention
24 millionwith Diabetes
57 millionwith Prediabetes
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1 in 3 Americans born in 2000 are expected to develop diabetes sometime during their lifetime…
1 in 3 Americans born in 2000 are expected to develop diabetes sometime during their lifetime…
Narayan, Boyle, Geiss, Saaddine, Thompson. Diabetes Care29(9):2114–2116, 2006
Diabetes: A Costly ProblemDiabetes: A Costly Problem
Increasing Economic Burden
persons with
diabetes
personswithout
diabetes
Health Care Expenditures Per Person 2007
$5,095 $11,74420071997
$98 Billion
$174Billion
Dall, T. et al. Economic Costs of Diabetes in the U.S. in 2007 Diabetes Care 31: 596-615, 2008.
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Division of Diabetes TranslationDivision of Diabetes Translation
Tracking the disease burdenConducting applied translation research to prioritize effective interventionsEconomic analysesDeveloping and maintaining state-based diabetes prevention and control programsImplementing National Program Initiatives:
National Diabetes Education ProgramNative Diabetes Wellness Program
Tracking the disease burdenConducting applied translation research to prioritize effective interventionsEconomic analysesDeveloping and maintaining state-based diabetes prevention and control programsImplementing National Program Initiatives:
National Diabetes Education ProgramNative Diabetes Wellness Program
Community and policyCommunity and policy
System, group, System, group, cultureculture
Family, Family, friends, small friends, small
groupgroup
IndividualIndividual
The health of individuals is inseparable from the health of communities (Healthy People 2010)
Ecological ModelEcological Model
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Age-adjusted Percentage of U.S. Adults with Obesity or Diagnosed Diabetes
Diabetes1994 2000 2007
No Data <4.5% 4.5-5.9% 6.0-7.4% 7.5-8.9% >9.0%
Obesity (BMI ≥30 kg/m2)1994 2000 2007
No Data <14.0% 14.0-17.9% 18.0-21.9% 22.0-25.9% >26.0%
0 5 10 15 20
Non-Hispanic whites
Asian Americans
Hispanic/Latino Americans
Non-Hispanic blacks
American Indians/Alaska Natives
Percent
Estimated Age-Adjusted* Prevalence of Diagnosed Diabetesin People Aged 20 Years or Older, by Race/Ethnicity,
United States, 2007
Estimated Age-Adjusted* Prevalence of Diagnosed Diabetesin People Aged 20 Years or Older, by Race/Ethnicity,
United States, 2007
*Based on the 2000 US standard population
CDC, National Diabetes Fact Sheet, 2007
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Tracking Diabetes:
State by State
Tracking Diabetes:
County Level EstimatesTracking Diabetes:
County Level EstimatesAvailable
Spring 2008
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Tracking Diabetes:
SEARCH for Diabetes in Youth
0
0.5
1
1.5
2
2.5
3
T1 T2
Prev
alen
ce (p
er 1
,000
)
NHW AA H API AI
T1 T2
0-9 Years 1010--19 Years19 Years
SEARCH Study Group, Pediatrics, 2006
Opportunities to Control DiabetesOpportunities to Control Diabetes
50-60% decrease Vision Loss
Foot Ulcers and Amputations
Kidney Failure,Vision Loss
leads to
Eye exams
Foot exams lead to
lead to
45-85% decrease
20-50% decrease
Narayan et al. 2006
lead toGlucosecontrol
Flu vaccine
lead to
lead to
Lipidcontrol
40% decrease
32% decrease
Hospitalization
Cardiovascular Disease
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> 2 A1c Tests in the Last Year 2000 and 2005
20052000
Age-adjusted rates per 100 adults with diabetes. Centers for Disease Control
and Prevention. Diabetes Surveillance System
at http://www.cdc.gov/diabetes/statistics/index.htm
Foot Exam in the Last Year 1995 and 2005
20051995
Age-adjusted rates per 100 adults with diabetes. Centers for Disease Control
and Prevention. Diabetes Surveillance System
at http://www.cdc.gov/diabetes/statistics/index.htm
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Eye Exams in the Last Year 1995 and 2005
20051995
Age-adjusted rates per 100 adults with diabetes. Centers for Disease Control
and Prevention. Diabetes Surveillance System
at http://www.cdc.gov/diabetes/statistics/index.htm
Progress in Control: Diabetes Outcomes1995 to 2005
Progress in Control: Diabetes Outcomes1995 to 2005
Vision Loss 25%Amputation 36%End Stage Renal Disease 23%CVD Hospitalization 16%Total Hospitalization 33%
Vision Loss 25%Amputation 36%End Stage Renal Disease 23%CVD Hospitalization 16%Total Hospitalization 33%
www.cdc.gov/diabetes
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Persons with Diagnosed DiabetesPersons with Diagnosed Diabetes
Total PopulationTotal Population
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Prevention of Type 2 DiabetesThe Community – Clinic Partnership Model
Prevention of Type 2 DiabetesThe Community – Clinic Partnership Model
Community Clinic
Total Population Pre-diabetes Diabetes Complications
Informed Population
Strong Community Organizations
Partnership Zone
Information Systems
Decision Support
Proactive Practice Team
Screening forHigh Risk
Diagnosis of Pre-diabetes
Lifestyle Weight ControlPrograms
Regular Glucose Monitoring
Insurers
Employers Reimbursement}
Healthy Public Policy
Supportive Environments Informed, ActivatedPatients
Control and Primary PreventionControl and Primary Prevention
Sustain and build on gains in control
Gain new resources for primary prevention
Sustain and build on gains in control
Gain new resources for primary prevention
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BASIC SCIENCE
EFFICACYEFFICACY
EFFECTIVENESSEFFECTIVENESS
EFFICIENCYEFFICIENCY
AVAILABILITYAVAILABILITY
DISTRIBUTIONDISTRIBUTION
Molecular/ physiologicalMolecular/
physiological
Ideal settingsIdeal
settings
Real world settings
Real world settings
Biggest effect on most people
Biggest effect on most people
SupplySupply
Diffusion of interventionsDiffusion of
interventionsPOLICY
POLICY
POLICY
PacifiCare Texas
Kaiser Permanente No. California
Pacific Health Research Institute
U. Michigan
Indiana U.
UCLAUMDNJ
CDC
Conducting Translational Research:
TRANSLATING RESEARCH INTO ACTION FOR DIABETES (TRIAD)
Veterans Health Administration / TRIAD Study Sites
NIDDK
National Institute of Digestive and Diabetes and Kidney Disorders
Translational Research Centers / TRIAD Study SitesCenters for Disease Control - Sponsor
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United States Territories
American SamoaFederated States of MicronesiaMarshall IslandsNorthern Mariana IslandsPalauPuerto RicoU.S. Virgin Islands
Implementing State and National Programs
National Diabetes Education Program_____________________•The Association of American Indian Physicians• Black Women's Health Imperative• Khmer Health Advocates• National Alliance for Hispanic Health• National Association of School Nurses• National Latina Health Network• National Medical Association• Papa Ola Lokahi.
Primary Prevention Pilots
Washington DC
Tribal Grantees
Implementing National Program Initiatives:
National Diabetes Education Program*
*NDEP is a joint initiative of CDC and NIH