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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

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VisionVision

World free of the devastation of diabetesWorld free of the devastation of diabetes