It’s ‘All Hands on Deck’ or Bust in National Diabetes Prevention Effort

The staggering numbers associated with Type 2 diabetes in the United States are enough to get any health professional down: 26 million currently diagnosed, 79 million with high enough blood sugar to be at highest risk for the disease.

If the trajectory of new diagnoses doesn’t change, says Ann Albright, director of the Division of Diabetes Translation for the Centers for Disease Control and Prevention (and Ohio State alumna), experts predict that one in three Americans will have diabetes by 2050.

“That is not sustainable,” Albright told attendees at the 2012 Global Diabetes Summit hosted by Ohio State’s Diabetes Research Center at Wexner Medical Center. “If we think prevention is difficult now, we ain’t seen nothing yet if we don’t get it together.”

But one intervention does not fit all at risk for diabetes, she noted, referring repeatedly to a “risk continuum.” People at low or moderate risk for diabetes cannot be cast aside in prevention efforts, but they are not the focus of the most ambitious prevention effort that the CDC is responsible for implementing.

The Diabetes Prevention Program (DPP) trial was an important milestone in national prevention efforts.

“It was vital for us to know whether or not we can say that you can prevent Type 2 diabetes in high-risk people,” Albright said. The trial showed that a lifestyle intervention aimed at dietary changes and increased physical activity was more effective than medicine at delaying or preventing high-risk individuals from developing diabetes.

As experts work to translate the program to communities in which high-risk people live, they note that one element of the DPP cannot practically be scaled to a national level: the one-on-one counseling each participant experienced.

Instead, the intervention now is offered in group settings, and an analysis of 28 studies of the effectiveness of group counseling suggested that average weight loss among participants was 4 percent – a bit shy of the goal of 5-7 percent weight loss.

An interesting finding: The weight loss was similar no matter which kind of leader hosted the counseling – a health professional or a lay educator. And this is why it’s an “all-hands-on-deck” situation, Albright said.

“If we build this on the backs of health professionals, we’ll never get where we need to go.”

The Affordable Care Act of 2010 authorized the CDC to lead a national DPP, “but this is not a CDC program. This belongs to the US and around the world,” she said. CDC is responsible for providing organizing infrastructure so a national DPP can be implemented in the United States.

Elements of that infrastructure include training to increase the work force; assuring quality; delivering the program at identified intervention sites; and marketing to increase referrals so the program is put to use on the scale required.

Participant engagement is vital, and the culture needs to shift so that community-based programs are “the thing to do, the place to be for diabetes prevention,” she said.

So far, the national program has served or is serving 9,000 people and is being run by more than 1,000 lifestyle coaches serving citizens in this country. Early data suggest weight loss achievement is about 4.9 percent, and that goes up to 5.1 percent among programs that have been running the longest. Retention is best after participants get through the first four sessions.

Planners are heartened by the results, but Albright warned that health gains being made in people currently diagnosed with diabetes are being overtaken by new cases, driving home now critical prevention of diabetes will be to the country’s economic and public health future.

“If we don’t do this,” she said, “one in three, one in three, one in three.”

-Emily Caldwell

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