1
|
Kornas K, Tait C, Negatu E, Rosella LC. External validation and application of the Diabetes Population Risk Tool (DPoRT) for prediction of type 2 diabetes onset in the US population. BMJ Open Diabetes Res Care 2024; 12:e003905. [PMID: 38453237 PMCID: PMC10921488 DOI: 10.1136/bmjdrc-2023-003905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/20/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION Characterizing diabetes risk in the population is important for population health assessment and diabetes prevention planning. We aimed to externally validate an existing 10-year population risk model for type 2 diabetes in the USA and model the population benefit of diabetes prevention approaches using population survey data. RESEARCH DESIGN AND METHODS The Diabetes Population Risk Tool (DPoRT), originally derived and validated in Canada, was applied to an external validation cohort of 23 477 adults from the 2009 National Health Interview Survey (NHIS). We assessed predictive performance for discrimination (C-statistic) and calibration plots against observed incident diabetes cases identified from the NHIS 2009-2018 cycles. We applied DPoRT to the 2018 NHIS cohort (n=21 187) to generate 10-year risk prediction estimates and characterize the preventive benefit of three diabetes prevention scenarios: (1) community-wide strategy; (2) high-risk strategy and (3) combined approach. RESULTS DPoRT demonstrated good discrimination (C-statistic=0.778 (males); 0.787 (females)) and good calibration across the range of risk. We predicted a baseline risk of 10.2% and 21 076 000 new cases of diabetes in the USA from 2018 to 2028. The community-wide strategy and high-risk strategy estimated diabetes risk reductions of 0.2% and 0.3%, respectively. The combined approach estimated a 0.4% risk reduction and 843 000 diabetes cases averted in 10 years. CONCLUSIONS DPoRT has transportability for predicting population-level diabetes risk in the USA using routinely collected survey data. We demonstrate the model's applicability for population health assessment and diabetes prevention planning. Our modeling predicted that the combination of community-wide and targeted prevention approaches for those at highest risk are needed to reduce diabetes burden in the USA.
Collapse
Affiliation(s)
- Kathy Kornas
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Christopher Tait
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ednah Negatu
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Laura C Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Temerty Faculty of Medicine, Department of Laboratory Medicine and Pathobiology, Toronto, Ontario, Canada
| |
Collapse
|
2
|
Ali MK, Imperatore G, Benoit SR, O'Brien MJ, Holliday CS, Echouffo-Tcheugui JB, McKeever Bullard K. Impact of changes in diabetes screening guidelines on testing eligibility and potential yield among adults without diagnosed diabetes in the United States. Diabetes Res Clin Pract 2023; 197:110572. [PMID: 36775024 PMCID: PMC10352955 DOI: 10.1016/j.diabres.2023.110572] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/23/2023] [Accepted: 01/31/2023] [Indexed: 02/12/2023]
Abstract
AIMS Recent USPSTF and ADA guidelines expanded criteria of whom to test to identify prediabetes and diabetes. We described which Americans are eligible and report receiving glucose testing by USPSTF 2015 and 2021 as well as ADA 2003 and 2022 recommendations, and performance of each guideline. METHODS We analyzed cross-sectional data from 6,007 non-pregnant U.S. adults without diagnosed diabetes in the 2013-2018 National Health and Nutrition Examination Surveys. We reported proportions of adults who met each guideline's criteria for glucose testing and reported receiving glucose testing in the past three years, overall and by key population subgroups,. Defining prediabetes (FPG 100-125 mg/dL and/or HbA1c 5.7-6.4 %) or previously undiagnosed diabetes (FPG ≥ 126 mg/dL and/or HbA1c ≥ 6.5 %), we assessed sensitivity and specificity. RESULTS During 2013-2018, 76.7 million, 90.4 million, 157.7 million, and 169.5 million US adults met eligibility for glucose testing by USPSTF 2015, 2021, and ADA 2003 and 2022 guidelines, respectively. On average, 52 % of adults reported receiving glucose testing within the past 3 years. Likelihood of receiving glucose testing was lower among younger adults, men, Hispanic adults, those with less than high school completion, those living in poverty, and those without health insurance or a usual place of care than their respective counterparts. ADA recommendations were most sensitive (range: 91.0 % to 100.0 %) and least specific (range: 18.3 % to 35.3 %); USPSTF recommendations exhibited lower sensitivity (51.9 % to 66.6 %), but higher specificity (56.6 % to 74.5 %). CONCLUSIONS An additional 12-14 million US adults are eligible for diabetes screening. USPSTF 2021 criteria provide balanced sensitivity and specificity while ADA 2022 criteria maximize sensitivity. Glucose testing does not align with guidelines and disparities remain.
Collapse
Affiliation(s)
- Mohammed K Ali
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, United States; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States; Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, United States.
| | - Giuseppina Imperatore
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Stephen R Benoit
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Matthew J O'Brien
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Christopher S Holliday
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Justin B Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Metabolism, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Kai McKeever Bullard
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, United States
| |
Collapse
|
3
|
Chen Y, Zhou X, Bullard KM, Zhang P, Imperatore G, Rolka DB. Income-related inequalities in diagnosed diabetes prevalence among US adults, 2001-2018. PLoS One 2023; 18:e0283450. [PMID: 37053158 PMCID: PMC10101461 DOI: 10.1371/journal.pone.0283450] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 03/01/2023] [Indexed: 04/14/2023] Open
Abstract
AIMS The overall prevalence of diabetes has increased over the past two decades in the United States, disproportionately affecting low-income populations. We aimed to examine the trends in income-related inequalities in diabetes prevalence and to identify the contributions of determining factors. METHODS We estimated income-related inequalities in diagnosed diabetes during 2001-2018 among US adults aged 18 years or older using data from the National Health Interview Survey (NHIS). The concentration index was used to measure income-related inequalities in diabetes and was decomposed into contributing factors. We then examined temporal changes in diabetes inequality and contributors to those changes over time. RESULTS Results showed that income-related inequalities in diabetes, unfavorable to low-income groups, persisted throughout the study period. The income-related inequalities in diabetes decreased during 2001-2011 and then increased during 2011-2018. Decomposition analysis revealed that income, obesity, physical activity levels, and race/ethnicity were important contributors to inequalities in diabetes at almost all time points. Moreover, changes regarding age and income were identified as the main factors explaining changes in diabetes inequalities over time. CONCLUSIONS Diabetes was more prevalent in low-income populations. Our study contributes to understanding income-related diabetes inequalities and could help facilitate program development to prevent type 2 diabetes and address modifiable factors to reduce diabetes inequalities.
Collapse
Affiliation(s)
- Yu Chen
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Xilin Zhou
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Kai McKeever Bullard
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Ping Zhang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Giuseppina Imperatore
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Deborah B Rolka
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| |
Collapse
|
4
|
Mosst JT, DeFosset A, Sivashanmugam M, Kuo T. Exploring Reimbursement Options for the National Diabetes Prevention Program: Lessons Learned From a Pilot Project in Los Angeles, 2014-2018. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2021; 27:E119-E125. [PMID: 32011598 DOI: 10.1097/phh.0000000000001136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT Although Medicare and several state Medicaid programs are beginning to cover the cost of delivering the National Diabetes Prevention Program (National DPP), little is known about the logistical challenges to establishing reimbursement options for these services. OBJECTIVE To describe Los Angeles' experience working with payers to identify and establish reimbursement pathways for National DPP providers. DESIGN A case study was conducted to identify regional options for covering the costs of the National DPP. SETTING Los Angeles. PARTICIPANTS A managed care organization along with selected National DPP providers (those that provide in-person and/or online services) participated in this regional pilot project. INTERVENTION The Los Angeles County Department of Public Health explored and prototyped reimbursement options for the National DPP, using input from and participation by target health plans (payers) and program providers. MAIN OUTCOME MEASURE The establishment of a regional reimbursement approach for the National DPP. RESULTS Pilot project participants weighed the pros and cons of billing (Medicare/Medicaid)/reimbursing for program services directly, ultimately choosing to go with a third-party integrator that worked with payers to handle the administrative process of reimbursing program providers for their services. The integrator negotiated and obtained reimbursements on the behalf of the National DPP providers. CONCLUSIONS Lessons from this case study suggest an emerging need to build further capacity among National DPP providers, as they are often community-based organizations that are not equipped to bill Medicare/Medicaid directly for services. A third-party integrator represents a viable approach for addressing this logistical issue.
Collapse
Affiliation(s)
- Jennifer Torres Mosst
- Division of Chronic Disease and Injury Prevention, Los Angeles Department of Public Health, Los Angeles, California (Drs Mosst and Kuo and Mss DeFosset and Sivashanmugam); Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California (Dr Kuo); Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (Dr Kuo); and Population Health Program, UCLA Clinical and Translational Science Institute, Los Angeles, California (Dr Kuo)
| | | | | | | |
Collapse
|
5
|
Chen H, Zhou Y, Sun L, Chen Y, Qu X, Chen H, Rajbhandari-Thapa J, Xiao S. Non-communicable diseases are key to further narrow gender gap in life expectancy in Shanghai, China. BMC Public Health 2020; 20:839. [PMID: 32493253 PMCID: PMC7268263 DOI: 10.1186/s12889-020-08932-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 05/17/2020] [Indexed: 12/26/2022] Open
Abstract
Background To address change in the gender gap of life expectancy (GGLE) in Shanghai from 1973 to 2018, and to identify the major causes of death and age groups associated with the change over time. Methods The temporal trend in GGLE was evaluated using retrospective demographic analysis with Joinpoint regression. Causes of death were coded in accordance with the International Classification of Diseases and mapped with the Global Burden of Disease (GBD) cause list. The life table technique and decomposition method were used to express changes in GGLE. Results The trend of GGLE in Shanghai experienced two phases, i.e., a decrease from 8.4 to 4.2 years in the descent phase (1973–1999) and a fluctuation between 4.0 and 4.9 years in the plateau phase (1999–2018). The reduced age-specific mortality rates tended to concentrate to a narrower age range, from age 0–9 and above 30 years in the descent phase to age above 55 years in the plateau phase. Gastroesophageal and liver cancer, communicable, chronic respiratory, and digestive diseases were once the major contributors to narrow GGLE in the descent phase. While, importance should be attached to a widening effect on GGLE by lung cancer, cardiovascular diseases, other neoplasms like colorectal and pancreatic cancer, and diabetes in the recent plateau phase. Conclusions Non-communicable diseases (NCDs) have made GGLE enter a plateau phase from a descent phase in Shanghai, China. Public efforts to reduce excess mortalities for male NCDs, cancers, cardiovascular diseases, chronic respiratory diseases, and diabetes in particular and health policies focused on the middle-aged and elderly population might further narrow GGLE. This will also ensure improvements in health and health equity in Shanghai China.
Collapse
Affiliation(s)
- Hanyi Chen
- Department of Science Research and Information Management, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, 200136, China.,Fudan University Pudong Institute of Preventive Medicine, Shanghai, China
| | - Yi Zhou
- Department of Science Research and Information Management, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, 200136, China.,Fudan University Pudong Institute of Preventive Medicine, Shanghai, China
| | - Lianghong Sun
- Department of Science Research and Information Management, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, 200136, China.,Fudan University Pudong Institute of Preventive Medicine, Shanghai, China
| | - Yichen Chen
- Department of Science Research and Information Management, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, 200136, China.,Fudan University Pudong Institute of Preventive Medicine, Shanghai, China
| | - Xiaobin Qu
- Department of Science Research and Information Management, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, 200136, China.,Fudan University Pudong Institute of Preventive Medicine, Shanghai, China
| | - Hua Chen
- Department of Science Research and Information Management, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, 200136, China.,Fudan University Pudong Institute of Preventive Medicine, Shanghai, China
| | | | - Shaotan Xiao
- Department of Science Research and Information Management, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, 200136, China. .,Fudan University Pudong Institute of Preventive Medicine, Shanghai, China.
| |
Collapse
|
6
|
Ackermann RT, Kang R, Cooper AJ, Liss DT, Holmes AM, Moran M, Saha C. Effect on Health Care Expenditures During Nationwide Implementation of the Diabetes Prevention Program as a Health Insurance Benefit. Diabetes Care 2019; 42:1776-1783. [PMID: 31010870 PMCID: PMC6702599 DOI: 10.2337/dc18-2071] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 03/21/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Lifestyle interventions slow development of type 2 diabetes by half, but the impact of health payer reimbursement for delivery of intervention programs is not well known. We evaluated net commercial health payer expenditures when offering reimbursement for access to YMCA's Diabetes Prevention Program (YDPP) in 42 states. RESEARCH DESIGN AND METHODS We used a nonequivalent comparison group design to evaluate net health care expenditures for adults with prediabetes who attended one or more YDPP visit between 1 July 2009 and 31 May 2013 ("YDPP users"). Rolling, 1:1 nearest neighbor propensity score (PS) matching was used to identify a comparison group of nonusers. Administrative data provided measures of YDPP attendance, body weight at YDPP visits, and health care expenditures. Random effects, difference-in-difference regression was used to estimate quarterly health care expenditures before and after participants' first visit to YDPP. RESULTS Worksite screening identified 9.7% of the target population; 39.1% of those identified (19,933 participants through June 2015) became YDPP users. Mean weight loss for YDPP users enrolled before June 2013 (n = 1,725) was 7.5 lb (3.4%); 29% achieved ≥5% weight loss. Inclusive of added costs to offer YDPP, there were no statistically significant differences in mean per-person net health care expenditures between YDPP users and PS-matched nonusers over 2 years ($0.2 lower [95% CI $56 lower to $56 higher]). Mean reimbursement to the YMCA was $212 per YDPP user, with 92.8% of all expenditures made for those who attended at a high rate (≥9 completed YDPP visits). CONCLUSIONS Worksite screening was inefficient for identifying the population with prediabetes, but those identified achieved modest YDPP attendance and clinically meaningful weight loss. Over 2 years, added costs to offer the intervention were modest, with neutral effects on net health care costs.
Collapse
Affiliation(s)
- Ronald T Ackermann
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL .,Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Raymond Kang
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.,Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Andrew J Cooper
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - David T Liss
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.,Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ann M Holmes
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indiana University-Purdue University Indianapolis, Indianapolis, IN
| | - Margaret Moran
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Chandan Saha
- Indiana University School of Medicine, Indianapolis, IN
| |
Collapse
|
7
|
Gruss SM, Nhim K, Gregg E, Bell M, Luman E, Albright A. Public Health Approaches to Type 2 Diabetes Prevention: the US National Diabetes Prevention Program and Beyond. Curr Diab Rep 2019; 19:78. [PMID: 31385061 PMCID: PMC6682852 DOI: 10.1007/s11892-019-1200-z] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW This article highlights foundational evidence, translation studies, and current research behind type 2 diabetes prevention efforts worldwide, with focus on high-risk populations, and whole-population approaches as catalysts to global prevention. RECENT FINDINGS Continued focus on the goals of foundational lifestyle change program trials and their global translations, and the targeting of those at highest risk through both in-person and virtual modes of program delivery, is critical. Whole-population approaches (e.g., socioeconomic policies, healthy food promotion, environmental/systems changes) and awareness raising are essential complements to efforts aimed at high-risk populations. Successful type 2 diabetes prevention strategies are being realized in the USA through the National Diabetes Prevention Program and elsewhere in the world. A multi-tiered approach involving appropriate risk targeting and whole-population efforts is essential to curb the global diabetes epidemic.
Collapse
Affiliation(s)
- Stephanie M. Gruss
- 0000 0001 2163 0069grid.416738.fDivision of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Hwy., Mailstop F75, Atlanta, GA 30341 USA
| | - Kunthea Nhim
- 0000 0001 2163 0069grid.416738.fDivision of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Hwy., Mailstop F75, Atlanta, GA 30341 USA
| | - Edward Gregg
- 0000 0001 2113 8111grid.7445.2Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Miriam Bell
- 0000 0001 2163 0069grid.416738.fDivision of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Hwy., Mailstop F75, Atlanta, GA 30341 USA
| | - Elizabeth Luman
- 0000 0001 2163 0069grid.416738.fDivision of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Hwy., Mailstop F75, Atlanta, GA 30341 USA
| | - Ann Albright
- 0000 0001 2163 0069grid.416738.fDivision of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Hwy., Mailstop F75, Atlanta, GA 30341 USA
| |
Collapse
|
8
|
Abstract
OBJECTIVE The internet has become a vital resource through which patients learn about medical conditions. The aim of this study was to assess the quality and readability of online information about nutrition and diabetes management. METHODS An internet search was conducted using three search terms of varying sophistication (how to eat with diabetes, diabetes diet, and medical nutrition therapy for diabetes) and the three most popular search engines (Yahoo, Bing, and Google). Forty-two websites were prospectively analyzed for quality of information and assessed for readability using the Flesch-Kincaid score. RESULTS The 42 websites reviewed demonstrated wide variability in quality, regardless of the search term entered. The reading level required to understand the materials varied based on sophistication of the search term and ranged from the 6th- to the 11th-grade level. CONCLUSIONS The quality of online information on nutrition education for patients with diabetes was extremely variable and readability often was higher than the average American reading level (8th grade). An awareness of quality and readability of the materials found on the internet can strengthen the patient-provider relationship.
Collapse
|
9
|
Haire-Joshu D, Hill-Briggs F. The Next Generation of Diabetes Translation: A Path to Health Equity. Annu Rev Public Health 2019; 40:391-410. [PMID: 30601723 DOI: 10.1146/annurev-publhealth-040218-044158] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Disparities in diabetes burden exist in large part because of the social determinants of health (SDOH). Translation research and practice addressing health equity in diabetes have generally focused on changing individual behavior or providing supportive approaches to compensate for, rather than directly target, SDOH. The purpose of this article is to propose a pathway for addressing SDOH as root causes of diabetes disparities and as an essential target for the next generation of interventions needed to achieve health equity in diabetes prevention and treatment. This review describes ( a) the current burden of diabetes disparities, ( b) the influence of SDOH on diabetes disparities, ( c) gaps in and implications of current translation research, and ( d) approaches to achieving health equity in the next generation of diabetes translation.
Collapse
Affiliation(s)
- Debra Haire-Joshu
- Public Health and Medicine, Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA;
| | - Felicia Hill-Briggs
- Departments of Medicine; Health, Behavior and Society; and Acute and Chronic Care; and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA;
| |
Collapse
|
10
|
Bowen ME, Schmittdiel JA, Kullgren JT, Ackermann RT, O'Brien MJ. Building Toward a Population-Based Approach to Diabetes Screening and Prevention for US Adults. Curr Diab Rep 2018; 18:104. [PMID: 30229480 PMCID: PMC6953473 DOI: 10.1007/s11892-018-1090-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE OF REVIEW Evidence-based treatments for prediabetes can prevent and delay the development of type 2 diabetes in adults. In this review, we propose a framework for population-based diabetes prevention that links screening and prevention activities across key stakeholders. We also discuss gaps in current practice, while highlighting opportunities to improve diabetes screening and prevention efforts population-wide. RECENT FINDINGS Awareness of diabetes risk is low, and many adults with prediabetes are not identified through existing screening efforts. Accumulating evidence and policies support expansion of the Diabetes Prevention Program (DPP) into clinical and community settings. However, the infrastructure to facilitate referrals and promote data exchange among patients, clinical settings, and community-based DPP programs is lacking. Development of evidence-driven, scalable processes for assessing diabetes risk, screening eligible adults, and delivering preventive treatments are needed to effectively improve the glycemic health of the US adult population.
Collapse
Affiliation(s)
- Michael E Bowen
- Division of General Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9169, USA.
- Division of Outcomes and Health Services Research, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | | | - Jeffrey T Kullgren
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ronald T Ackermann
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Northwestern University Institute for Public Health and Medicine, Chicago, IL, USA
| | - Matthew J O'Brien
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Northwestern University Institute for Public Health and Medicine, Chicago, IL, USA
| |
Collapse
|
11
|
Farjam M, Bahrami H, Bahramali E, Jamshidi J, Askari A, Zakeri H, Homayounfar R, Poustchi H, Malekzadeh R. A cohort study protocol to analyze the predisposing factors to common chronic non-communicable diseases in rural areas: Fasa Cohort Study. BMC Public Health 2016; 16:1090. [PMID: 27756262 PMCID: PMC5069851 DOI: 10.1186/s12889-016-3760-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 10/11/2016] [Indexed: 12/12/2022] Open
Abstract
Background Non-communicable diseases (NCDs) have become the main causes of morbidity and mortality even in rural areas of many developing countries, including Iran. In view of this increased risk, Fasa Cohort Study (FACS) has been established to assess the risk factors for NCDs with the ultimate goal of providing optimal risk calculators for Iranian population and finding grounds for interventions at the population level. Methods In a population-based cohort, at least 10,000 people within the age range of 35 to 70 years old from Sheshdeh, the suburb of Fasa city and its 24 satellite villages are being recruited. A detailed demographic, socioeconomic, anthropometric, nutrition, and medical history is obtained for each individual besides limited physical examinations and determination of physical activity and sleep patterns supplemented by body composition and electrocardiographic records. Routine laboratory assessments are done and a comprehensive biobank is compiled for future biological investigations. All data are stored online using a dedicated software. Discussion FACS enrolls the individuals from rural and little township areas to evaluate the health conditions and analyze the risk factors pertinent to major NCDs. This study will provide an evidence-based background for further national and international policies in preventive medicine. Yearly follow ups are designed to assess the health events in the participating population. It is believed that the results would construct a contemporary knowledge of Iranian high risk health characteristics and behaviors as well as the platform for further interventions of risk reduction in a typical Iranian population. Constantly probing for future advances in NCDs prevention and management, the accumulated database and biobank serves as a potential for state of the art research and international collaborations.
Collapse
Affiliation(s)
- Mojtaba Farjam
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran.,Department of Medical Pharmacology, Fasa University of Medical Sciences, Fasa, Iran
| | - Hossein Bahrami
- Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA.,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Ehsan Bahramali
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran. .,Cardiology Department, Fasa University of Medical Sciences, Fasa, Iran.
| | - Javad Jamshidi
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran.,Department of Medical Genetics, Fasa University of Medical Sciences, Fasa, Iran
| | - Alireza Askari
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Habibollah Zakeri
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran.,Anesthesiology Department, Fasa University of Medical Sciences, Fasa, Iran
| | - Reza Homayounfar
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Hossein Poustchi
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Malekzadeh
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
12
|
Abstract
Mohammed Ali and Venkat Narayan describe the challenge of implementing evidence-based interventions for prevention for the large number of people at increased risk of type 2 diabetes.
Collapse
Affiliation(s)
- Mohammed K. Ali
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - K. M. Venkat Narayan
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| |
Collapse
|