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Translation in diabetes may lead to better outcomes
Diabetes educators can help to bridge the gap between diabetes research and improved outcomes for people with diabetes.
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Diabetes educators may help translate research evidence into practice by collaborating with researchers and practitioners.
“Translational diabetes research seeks to answer questions that are directly applicable to real-world settings; translation is the act of transforming knowledge into action,” said Ann L. Albright, PhD, RD, director of the division of diabetes translation at the National Center for Chronic Disease Prevention and Health Promotion at the CDC.
The prevalence of diabetes has increased rapidly since the 1990s – about 5% per year — possibly due to changes in diagnostic criteria, enhanced case detection, decreased mortality and true increase in incidence, she said at the 34th Annual Meeting of the American Association of Diabetes Educators, held in St. Louis.
“Men with diabetes are living longer, while the mortality rate in women has not declined,” Albright told Endocrine Today.
An estimated 21 million people have diabetes, about 54 million people have prediabetes, both likely an underestimate, according to Albright. From 2000 to 2050, the CDC projected an increase in diagnosed diabetes by 165%. They also estimate the lifetime diabetes risk for those born in 2000 to be one in three for males, two in five for females and one in two for Hispanic females.
“We would like to see the prevalence of diabetes decrease, but decrease because we have fewer newer cases of diabetes,” she said. “We should not use prevalence of diabetes alone as a marker for success in addressing diabetes.”
Prevention in practice
Albright said that there have been some improvements in preventive care practices, specifically a decline in those dying from hyperglycemic crisis. There has also been a trend toward decline in those going into renal failure and in amputation rates.
“It is important that the picture of diabetes is beginning to improve, but we still have a long way to go,” she said.
Increased efforts and resources are needed for preventing new cases of type 2 diabetes, according to Albright. She cited data from a study that modeled lifetime progression of diabetes costs and quality of life for adults aged 50 to 65 with impaired glucose tolerance. The study showed that 37% of new cases of diabetes may be prevented in people aged 65 years or younger at a cost of $1,300 per quality adjusted life year gained. If private payers reimbursed $655 (24%) of the total discounted intervention during the first three years, they would recover all of the costs in the form of medical costs avoided.
“There is not only a moral case, but also an economic case,” she said. “There are data forecasting what we are in store for, if we do not invest.”
Data from studies showed a need for continued diabetes care and prevention improvement among subgroups as well, according to Albright.
When examining major cardiovascular risk factors according to income level from 1971 to 2000, smoking rates remained elevated and diabetes prevalence was highest among low income earners. There was an overall decline in hypertension that has plateaued in all income groups. While cholesterol levels have declined among all income groups, high-income earners and low-income earners had higher levels than middle-income earners until recently, according to data cited by Albright. Mortality rates in the 1970s, 1980s and 1990s for those with and without diabetes declined in men and women without diabetes, but rates in women with diabetes did not decline.
“The picture of diabetes provided by data from many different types of research should guide us in the decisions we make at the program level and in what policies we advocate,” she said.
Changing diabetes
“To change we need more diabetes translation. The AADE has been gearing up in the arena of translation to help people understand information and incorporate it into their lives,” Albright said. “More translation research that seeks to answer questions that are directly applicable to real world settings is imperative to improving diabetes prevention and control.”
Translating Research Into Action for Diabetes (TRIAD) was a national, multicenter translational research study that measured 66 provider groups and 10 health plans. It was diverse in age, sex, race, ethnicity, socioeconomic status, geography and system type. TRIAD data showed that disease management approaches were associated with better process of care, but they were not necessarily associated with better related outcomes.
Processes of care were similar across race and ethnic groups, but nonwhite patients had higher HbA1c levels and blacks had higher systolic blood pressure than whites. Out-of-pocket costs were a barrier to retinal exams, health education and self-monitoring of blood glucose.
TRIAD data demonstrated that certain people were at higher risk for complications, specifically lower educated people and young men who smoke. Women with diabetes were less likely than men to have appropriate cardiovascular risk management. Care was suboptimal for people at risk for kidney disease.
“We need to take a serious look at the evidence,” Albright said. “We clearly need efficacy trials, clinical effectiveness trials and, most importantly, more translational research.”
Closing diabetes research gap
Studies have also indicated that there are gaps between what is known and what is being experienced, according to Albright. She suggested that to close the gaps, all medical professionals should expand the definition of what constitutes evidence.
“Use mixed methods that combine the strengths of both quantitative and qualitative research methods, conduct practical trials, and encourage researchers and practitioners to coproduce knowledge and expand community-based, participatory research,” she recommended.
Diabetes educators are in a key position to close the gap, according to Albright. The role of the educator should be to coproduce translational research, champion translational research and actively participate in transforming knowledge into action.
“We have to change the course of diabetes to change the picture of diabetes,” she said. “We need to be actively cultivating future generations of leaders in diabetes. Tomorrow our picture of diabetes should show many more people who are living healthy and productive lives, and ultimately fewer new cases of diabetes.” – by Christen Haigh
For more information:
- Albright AL. Pictures at an exhibition: diabetes educators in diabetes translation. G03. Presented at: the 34th Annual Meeting of the American Association of Diabetes Educators; August 1-4, 2007; St. Louis.