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Dttac.org

Information You Can Use
September 24, 2010
About this Newsletter
Information You Can Use features resources and information that may be of interest to state and territorial diabetes prevention and control programs (DPCPs) on diabetes and public health topics. The information
contained in this newsletter does not necessarily reflect the views of the Centers for Disease Control and
Prevention - Division of Diabetes Translation, nor does it represent CDC/DDT endorsement.
CDC Updates
1) See you at The Institute!! (October 4-7th, Emory Conference Center)
We’re looking forward to seeing al of you in Atlanta next week for the 2010 Institute and Diabetes Prevention and Control Program Directors’ Meeting on October 4-7. There wil be a welcome reception for participants on Sunday evening from 5:30-7:30 p.m. On Monday morning, October 4th, join us for breakfast and registration at 7:00 a.m., followed by the opening plenary session at 8:30 a.m. A complete agenda for the week is available at: Please contact if you have any questions about your registration.
2) A Message from Our New DTTAC Director, Linelle Blais, PhD, CPF

I am excited to serve as the new Director of the Diabetes Training and Technical Assistance Center (DTTAC)
team and as an Associate Professor at the Rollins School of Public Health. As a health psychologist and
certified professional facilitator, my professional interests are in people, programs, and practice. My
experiences include translating programs to practice, coaching for performance, strengthening partnerships,
leading planning and facilitation efforts, and designing initiatives in professional development. Prior to
Emory, I worked at the American Cancer Society’s National Home Office where I moved from directing
applied research and evaluation to leading nationwide capacity building initiatives as a National Vice
President in Field Operations and Talent Strategy. As a Rhode Island native, I worked at the Cancer
Prevention Research Center at the University of Rhode Island, where I conducted health behavior change
research and theory-testing. At Brown University’s Center for Gerontology and Health Care Research, I
worked on cancer patients’ unmet needs. I also worked on the Pawtucket Heart Health Project, a large scale
community intervention. My leisure activities are child-centric; I have a 15 year old daughter (Sophie) and a
12 year old son (Adam). Together with my husband, you can find us playing tennis, doing art projects,
digging in the garden, or preparing for yet another impromptu house party. (My secret pleasure? Listening
to live music at local hole-in-the-wall venues.) I’m looking forward to meeting you all at The Institute next
week!

3) Invitation to Participate in a Conference Call with Surgeon General Regina Benjamin


Federal staff and partners are cordially invited to participate in a conference call with the Surgeon General
this Friday, October 1, at 11 a.m. Eastern to learn about two historic opportunities created by the
Affordable Care Act:
The National Prevention, Health Promotion and Public Health Council, chaired by Dr. Benjamin and
composed of senior cabinet-level officials across federal agencies, and the development and
implementation of the National Prevention and Health Promotion Strategy.
Dr. Benjamin is conducting this outreach cal to engage the public and professionals in the development of the National Prevention and Health Promotion Strategy. More information is provided on attachment #1 and at the following link: To connect to the call, dial 1-888-283-2975 (Passcode: 1862596). Due to the large number of callers, please plan to call in 5-10 minutes ahead of time.
4) Diabetes-Related Episode of Army Wives
Wins First Place at the 2010 Sentinel for Health Awards
Congratulations to the CDC’s Division of Diabetes Translation for their work with Hollywood, Health & Society on the incorporation of diabetes into an episode of the Lifetime drama Army Wives. The episode won first place in the primetime drama category of the USC Annenberg Norman Lear Center's “Sentinel for Health Awards” for a storyline about a main character diagnosed with diabetes, and her struggles to accept her condition. Hollywood, Health & Society is a partnership of the Centers for Disease Control and Prevention (CDC), the California Endowment, the Bill & Melinda Gates Foundation, The National Institutes of Health, the Health Resources and Services Administration's Division of Transplantation, the White House Office of National Drug Control Policy, the Agency for Healthcare Research and Quality, and the USC Annenberg School's Norman Lear Center. "Television writers and producers are in a unique position both to entertain and to inform viewers," said Martin Kaplan, the Norman Lear Chair at the USC Annenberg School for Communication & Journalism and Director of the Lear Center. "The Sentinel for Health Awards give us a chance to shine a spotlight on master storytellers who use their power not only to write compelling shows, but also to educate audiences about crucial issues." Watch the clip at:
5) Chronic Disease Cost Calculator
To help states estimate the burden and financial impact of chronic diseases among their Medicaid beneficiaries, and to inform decisions on investments in chronic disease prevention and disease management programs, the CDC and RTI International, in partnership with the Agency for Healthcare Research and Quality, the National Association of Chronic Disease Directors, and the National Pharmaceutical Council, developed the Chronic Disease Cost Calculator. The Chronic Disease Cost Calculator is a downloadable tool that supports states in: 1. Estimating state Medicaid expenditures for six chronic diseases – congestive heart failure, heart disease, stroke, hypertension, cancer, and diabetes.
2. Generating estimates of Medicaid costs for selected chronic diseases using customized inputs (e.g., Note: The Cost Calculator does not provide exact prevalence rates and Medicaid costs for the chronic diseases in each state. All reported numbers are estimates and could differ from actual values. The uncertainty in the estimates arises from a number of factors: the combination of several data sources, different levels of geographic detail available in the source data, and the fact that the parameters of the statistical analysis are themselves estimates. Due to differences in data sources and methods, the estimates will not necessarily agree with other cost estimates. When discrepancies occur between Cost Calculator estimates and other state Medicaid estimates, users should contact their state Medicaid Program or State Department of Health for clarification. Related Materials 6) DDT Announces Awards to Six “Vulnerable Populations” Grantees

The purpose of this new five-year cooperative agreement is to reduce morbidity and premature mortality
and eliminate health disparities associated with diabetes. This will be done by funding organizations to
mobilize community partners and assist them in effectively planning, developing, implementing, and
evaluating community-based interventions to reduce the risk factors that influence the disproportionate
burden of diabetes in vulnerable populations. This program will strengthen the reach and impact of ongoing
programs by complementing the Diabetes Prevention and Control Programs (DPCPs), the Native Diabetes
Wellness Program (NDWP), and the National Diabetes Education Program (NDEP). Grantees will participate
in mobilizing coalitions and partnerships, developing and implementing strategic plans, conducting
interventions with the broadest sustainable impact possible, establishing learning communities, and
evaluating progress. The six grantees are listed below in alphabetical order. More detailed information on
their proposed work is included in Attachment #1: Vulnerable Populations Grantees.

Association of American Indian Physicians
FOCUS: American Indian/Alaska Native Population
1225 Sovereign Row, Suite 103
Oklahoma City, OK 73108
(405) 946-7072

Association of Asian Pacific Community Health Organizations
FOCUS: Asian Americans, Native Hawaiians, and other Pacific Islander Populations
300 Frank H. Ogawa Plaza, Ste 620
Oakland, CA 94612
(510) 272-9536

Kentuckiana Regional Planning and Development Agency
FOCUS: Older Adult/Low SES Populations
11520 Commonwealth Drive
Louisville, KY 40299
(502) 266-6084

National Alliance for Hispanic Health
FOCUS: Hispanic Population
1501 Sixteenth Street, NW
Washington, DC 20036
(202) 387-5000

National Kidney Foundation of Michigan
FOCUS: African American/Low SES Populations
1169 Oak Val ey Dr
Ann Arbor, MI 48108-9674
(800) 482-1455


The Center for Appalachian Philanthropy
FOCUS: Rural Appalachian Population
546 Second Street, PO Box 643
Portsmouth, OH 45662
(740) 876-4262

7) Why H1N1 Still Matters: CDC Public Health Grand Rounds Broadcast
This special 1st anniversary session of the CDC’s Public Health Grand Rounds reviews the roles that preparedness, surveil ance, vaccine development, and risk communication played in the H1N1 response, discusses lessons learned, and tackles the myths and truths of this controversial and still relevant public health issue. Listen to the archived broadcast at the link provided above. Spotlight on DPCP Work
1) Visit Washington’s Diabetes Connection Web Portal
is the Web portal for members of the Washington State Diabetes Network to share and find information and resources on “al things diabetes in Washington and beyond”. Its purpose is to: • serve as a clearinghouse of activities, ideas, best practices, and links and resources relating to the • foster collaboration and communication within th and • provide useful, credible information to people and organizations doing work to prevent and control diabetes among the residents of Washington. Articles, Resources, & Events…FYI

1) HHS Webinar Series on Health Literacy
Access the links below to participate in these free Webinars on health literacy sponsored by the Department of Health and Human Services. All Webinars will be held from 2:00-3:00 p.m. Eastern Time. Oct. 6 Health Literacy 101, Janet Ohene-Frempong, MS • A health literacy primer. Are your communications making a difference with the people Oct. 20 Making Health Information Actionable and Engaging Margarita Hurtado, PhD and Sandy Hilfiker, MA • User-Centered approaches to Health Literacy • Register at: Nov. 3 Why Culture Makes a Difference Margarita Hurtado, PhD and Kay Loughrey, MPH • Special issues in communicating with older adults and minority populations
2) Free Continuing Medical Education (CME) Available on ReachMD.com

Go to the link above to view podcasts available on diabetes-related topics and earn CME. (Registration is required.) 3) Online Course Available: Beyond Numbers—Qualitative Research Methods, Application, and Analysis,
October 25-December 12, 2010

This seven-week online course sponsored by the Michigan Public Health Training Center is designed to
provide participants with the knowledge and skills to identify appropriate methods for collecting qualitative
data, develop and conduct a qualitative research plan, and gain an appreciation of the role qualitative
research methods can play in understanding public health and related issues. Through readings, videos, and
hands-on exercises, participants will gain an in-depth understanding of the development of semi-structured
interview guides, the complexities of coding and textual analysis, and selection of participatory methods.
Continuing education credits are available; there is a $150 registration fee. For more information, or to
register, go to:

4) FDA Restricts Use of Avandia
On September 23, 2010, drug regulators in Europe and the United States reported that Avandia, an oral diabetes medication, will no longer be widely available. Approved in 1999, Avandia helps control blood glucose levels in people with diabetes by improving insulin sensitivity. It is one of a class of three drugs, the first of which, Rezulin, was withdrawn because it caused liver damage. Actos* is the last remaining drug in the class. Avandia wil be suspended entirely in Europe, while patients in the United States will be allowed access to the medication only if other treatment options have been exhausted and patients have been made aware of the drug’s substantial risks to the heart. (* The FDA announced on September 17 that it has begun a safety review of the diabetes drug Actos [pioglitazone], after receiving preliminary results from a long-term observational study designed to evaluate the risk of bladder cancer associated with use of this drug. Preliminary results are based on five-year data from an ongoing, 10-year observational study by the manufacturer, Takeda Pharmaceuticals North America Inc. These early results showed no overall association between Actos exposure and risk of bladder cancer. However, there was an increased risk of bladder cancer in patients with the longest exposure to Actos and in those with the highest cumulative dose of the drug. At this time, the FDA’s review is ongoing.)
5) Coming Soon…New Data Available from the U.S. Census Bureau’s American Community Survey
For the first time, the U.S. Census Bureau is planning to release a 5-year American Community Survey data file that includes all areas of the U.S. To help users prepare, the Census Bureau has posted a 5-Year Data Product Preview featuring the lists of tables, profiles, maps, and geographies scheduled for release starting in December, 2010. This information is available at: Also available is the American Community Survey (ACS) e-Tutorial. This interactive program will educate users on a wide range of topics, such as how communities benefit from participating in the survey and how to access data using the updated version of American FactFinder (AFF). The e-Tutorial can be accessed directly 6) Integrating Nurse-Directed Diabetes Management into a Primary Care Setting. Davidson MB, et al. Am J
This observational study was designed to compare outcome measures of nurse-directed diabetes management for 9 to 12 months between a nonintegrated model (patients removed from the primary care clinic and followed in a separate diabetes clinic with supervision by an endocrinologist) and an integrated model (nurse placed in the primary care clinic with supervision by primary care physicians). Nurses were trained to follow approved treatment algorithms (glycemia and dyslipidemia algorithms for both models plus a hypertension algorithm for the integrated model) and were given prescription authority. A total of 367 patients were randomly selected from a primary care clinic for the nonintegrated model, and 178 patients were referred to the nurse by primary care physicians for the subsequent integrated model. Key takeaway points from this study include the following: • Incorporation of an integrated model of diabetes care (nurse placed in the primary care clinic with supervision by primary care physicians) will markedly improve glycemia, lipids, and blood pressure (BP) in the short term and will decrease clinical events and save money in the long term. • In the nonintegrated model (patients removed from the primary care clinic and followed in a separate diabetes clinic with supervision by an endocrinologist) and integrated model, respectively, 60% and 49% met the American Diabetes Association (ADA) A1C goal, and 82% and 96% met the low-density lipoprotein cholesterol (LDL-C) goal. • In the integrated model, 90% met the BP goal, and 47% met al 3 goals (ADA A1C, LDL-C, and BP). The authors concluded that an integrated model of diabetes care is generalizable and should be considered by policy makers to improve diabetes outcomes, especial y among underserved minority populations. 7) Prevalence and Correlates of Elevated Blood Pressure in Youth with Diabetes Mellitus: The SEARCH for
Diabetes in Youth Study. Rodriguez BL, et al. J Pediatr. 2010 Aug;157(2):245-51.

This study was conducted to determine the prevalence and correlates of elevated blood pressure (BP) in youth with type 1 or type 2 diabetes mellitus by using data from the DDT-supported SEARCH Study. The analysis included youth aged 3 to 17 years with type 1 (n = 3691) and type 2 diabetes mel itus (n = 410) who attended a research visit. Elevated BP was defined as systolic or diastolic values ≥95 percentile, regardless of drug use. In youth with elevated BP, awareness was defined as a self-report of an earlier diagnosis. Control was defined as BP values <90th percentile and <120/90 mm Hg in youth with an earlier diagnosis who were taking BP medications. Results indicated that the prevalence of elevated BP in youth with type 1 diabetes mellitus was 5.9%. Minority ethnic groups, obese adolescents, and youth with poor glycemic control were disproportionately affected. In contrast, 23.7% of adolescents with type 2 diabetes mellitus had elevated BP (P < .0001). Similarly, 31.9% of youth with type 2 diabetes mellitus and elevated BP were aware that their blood pressure was elevated, compared with only 7.4% of youth with type 1 diabetes mellitus (P < .0001). Once BP was diagnosed and treated, control was similar in type 1 (57.1%) and type 2 diabetes mellitus (40.6%). These findings identify high-risk groups of youth with diabetes mellitus at which screening and treatment efforts should be directed. 8) Residence in a Distressed County in Appalachia as a Risk Factor for Diabetes, Behavioral Risk Factor
Surveillance System, 2006-2007. Barker, et al. Prev Chronic Dis. 2010;7(5).

The authors compared the risk of diabetes for residents of Appalachian counties to that of residents of non-
Appalachian counties after controlling for selected risk factors in states containing at least 1 Appalachian
county. They combined Behavioral Risk Factor Surveillance System data from 2006 and 2007 and conducted
a logistic regression analysis, with self-reported diabetes as the dependent variable. The authors considered county of residence (5 classifications for Appalachian counties, based on economic development, and 1 for non-Appalachian counties), age, sex, race/ethnicity, education, household income, smoking status, physical activity level, and obesity to be independent variables. The classification “distressed” refers to counties in the worst 10%, compared with the nation as a whole, in terms of 3-year unemployment rate, per capita income, and poverty. Controlling for covariates, residents in distressed Appalachian counties had 33% higher odds (95% confidence interval, 1.10-1.60) of reporting diabetes than residents of non-Appalachian counties. No significant differences between other classifications of Appalachian counties and non-Appalachian counties were found. The authors concluded that residents of distressed Appalachian counties are at higher risk of diabetes than are residents of other counties. States with distressed Appalachian counties should implement culturally sensitive programs to prevent and control diabetes.
9) Lifestyle Intervention for Overweight Patients with Diabetes Provides Long-Term Benefits. Wing R, et al.
Arch Intern Med. 2010;170[17]:1566-1575. Results from the Look AHEAD (Action for Health in Diabetes) Study released in the September 27 issue of Archives of Internal Medicine show that intensive lifestyle intervention appears to help individuals with type 2 diabetes lose weight and keep it off, along with improving fitness, control of blood glucose levels, and risk factors for cardiovascular disease. The Look AHEAD (Action for Health in Diabetes) Research Group conducted a multicenter randomized clinical trial comparing the effects of an intensive lifestyle intervention to traditional diabetes support and education among 5,145 overweight or obese individuals (average age 58.7) with type 2 diabetes. Of these, 2,570 were assigned to the lifestyle intervention group which consisted of a combination of dietary modification and physical activity designed to induce a 7 percent weight loss in the first year and maintain it in subsequent years. Participants were seen and contacted by phone at least monthly for al four years. The 2,575 individuals assigned to the diabetes support and education group were invited to three group sessions each year focusing on diet, physical activity, and social support. On average across the four-year period, individuals in the lifestyle intervention group lost a significantly larger percentage of their weight than did those in the diabetes support group (6.2 percent vs. 0.9 percent). They also experienced greater improvements in fitness, A1C levels, blood pressure control, and levels of high-density lipoprotein cholesterol (HDL). Conversely, individuals in the diabetes support group experienced greater reductions in low-density lipoprotein cholesterol (LDL), owing to greater use of cholesterol-lowering medications in this group. At the end of four years, the lifestyle intervention group maintained greater improvements in weight, fitness, A1C levels, systolic blood pressure, and HDL levels. “Although the differences between the two groups were greatest initial y and decreased over time for several measures, the differences between the groups averaged across the four years were substantial and indicate that the intensive lifestyle intervention group spent a considerable time at lower cardiovascular disease risk,” the authors reported in a September 24th press release. “The critical question is whether the differences between groups in risk factors wil translate into differences in the development of cardiovascular disease,” they continued. “These results will not be available for several years. However, effects of the magnitude that we observed for fitness, HDL-C and A1C levels, and blood pressure have been associated with decreased cardiovascular events and mortality in previous medication trials and observational studies. Moreover, there may be long-term beneficial effects from the four-year period in which intensive lifestyle intervention participants have been exposed to lower cardiovascular disease risk factors, as seen in other clinical trials.” More information on the Look AHEAD study is available at:

Source: http://dttac.org/resources/archives/2010/09.24.10_IYCU.pdf

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