TY - JOUR
T1 - The Next Generation of Diabetes Translation
T2 - A Path to Health Equity
AU - Haire-Joshu, Debra
AU - Hill-Briggs, Felicia
N1 - Funding Information:
The prevention and treatment of diabetes are dependent on the equitable translation of scientific evidence to populations at large. The primary focus of health disparities research to date has been on what we define as compensatory interventions, designed to improve outcomes at the individual level, for the individual who is receiving the intervention, for as long as that individual is receiving that intervention. These compensatory approaches have achieved a level of success in preventing and treating diabetes. The Diabetes Prevention Program (DPP) is one of the best examples to date of the impact of individually focused strategies to prevent and treat diabetes in the United States: from a National Institutes of Health (NIH) multicenter efficacy trial with a multiethnic study population, to effectiveness studies in translational settings, to national US policy, to standardized program and training/certifications under the oversight of the Centers for Disease Control and Prevention (CDC), to Medicare reimbursement via public health/non–health care channels (27). This landmark study demonstrated that both lifestyle and pharmacological interventions prevent or delay the onset of T2DM in high-risk, prediabetes populations by 25–60% at follow-up; the largest reductions were accomplished through lifestyle interventions (72, 73, 132).The DPP was time and resource intensive, requiring individual case managers or lifestyle coaches; frequent contact; a structured, 16-session core curriculum; supervised physical activity; a maintenance intervention; and other support (72, 128). Reviews of real-world DPP translation programs reported clinically significant (4–5%) weight loss and high reductions in the incidence of T2DM, achieved by lay educators delivering more realistic, less intensive interventions, with outcomes dependent in part on the number and intensity of sessions offered as well as on attendance (5, 46, 140). The YMCA also provided the DPP to Medicare beneficiaries with prediabetes in participating YMCAs nationwide (1, 6), reducing medical spending and utilization, inpatient admissions, and emergency department visits. In 2010, the National DPP (NDPP) was authorized by Congress to build an infrastructure of community-based programs across the country (74), with new regulations expanding CMS coverage for Medicare beneficiaries in 2015 (91, 125). As mandated and funded by Congress, the Indian Health Service implemented the Special Diabetes Program for Indians demonstration project, translating the DPP lifestyle intervention across rural, reservation, and urban American Indian/Alaska Native communities (62).
Publisher Copyright:
Copyright © 2019 by Annual Reviews. All rights reserved.
PY - 2019/4
Y1 - 2019/4
N2 - 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.
AB - 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.
KW - SDOH
KW - diabetes translation
KW - dissemination and implementation
KW - health equity
KW - root causes of health disparities
KW - social determinants of health
UR - http://www.scopus.com/inward/record.url?scp=85063861185&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85063861185&partnerID=8YFLogxK
U2 - 10.1146/annurev-publhealth-040218-044158
DO - 10.1146/annurev-publhealth-040218-044158
M3 - Review article
C2 - 30601723
AN - SCOPUS:85063861185
VL - 40
SP - 391
EP - 410
JO - Annual Review of Public Health
JF - Annual Review of Public Health
SN - 0163-7525
ER -