Prevention: A Blueprint for Action. Action Steps for HHS/Diabetes

04/01/2004

HHS agencies are pursuing vigorous programs in prevention that include basic research, clinical trials, community health efforts, educational programs, translating research into practice, efforts in special populations, and providing a new Medicare benefit for diabetes testing. Through these comprehensive programs, HHS agencies are continuing to pursue prevention studies to optimize and identify additional intervention strategies. HHS also is improving methods to disseminate and implement effective strategies into diverse community settings. Particular opportunities for HHS action involve underserved or vulnerable populations and include:

  • To focus attention on the long-term implications of gestational diabetes mellitus (GDM), the National Diabetes Information Clearinghouse of the NIDDK/NIH will produce a new booklet entitled, “What I Need to Know about Gestational Diabetes,” which will incorporate messages based on diabetes prevention research.  The National Diabetes Education Program’s Small Steps. Big Rewards. Prevent Type 2 Diabetes campaign will also be expanded to include a specific focus on GDM.
  • ·        To analyze the effects of treatment and ascertain the durability of these effects over time, a Diabetes Prevention Program follow-up study of women with a history of GDM is in progress.
  • Enhance the focus on women with GDM in community health centers and Indian Health Service programs, and through AHRQ’s Integrated Delivery System Research Network and Practice Based Research Networks.
  • Since there is a disproportionate risk for the development of type 2 diabetes in persons with serious mental illness, in general, and treatment with antipsychotic medications predispose individuals to gain weight [49-54] , examine and apply evidence-based lifestyle interventions in mental health settings that would reduce the rate of obesity and prevent the development of type 2 diabetes in Americans with serious mental illness.
  • Since American Indians and Alaska Natives have a higher incidence of diabetes, determine if diabetes prevention activities previously demonstrated to be efficacious under well-controlled conditions (such as the NIDDK-sponsored Diabetes Prevention Program study) can be implemented with fidelity in a variety of Indian health settings and through community-based human services providers.
  • Evaluate whether a comprehensive health system intervention delivered through Indian health programs can reduce risk factors for cardiovascular disease in individuals with diabetes and/or the metabolic syndrome ( characterized by insulin resistance and the presence of obesity, abdominal fat, high blood sugar and triglycerides, high blood cholesterol, and high blood pressure).
  • Implement evidenced-based interventions to prevent diabetes as part of the Primary Prevention of Diabetes Initiative in 25-30 Health Service/Tribal/Urban (I/T/U) community sites of varying sizes and types. 
  • Implement, as part of the Cardiovascular Disease Risk Reduction Initiative, a comprehensive health system intervention consisting of patient-, provider-, systems- and community-level components in 25-30 clinical sites that participate in the IHS Diabetes Care and Outcomes Audit.
  • Consider utilizing the community health center program Diabetes Prevention Collaborative and Health Disparity Collaborative strategy and models to translate and disseminate the results of Diabetes Prevention Program pilot into clinical practice.
  • Incorporate the findings from the recently released reports on health literacy from the Institute of Medicine and AHRQ into diabetes information and communication activities.
  • CMS should assess utilization of the new Medicare benefits (beginning in 2005) establishing coverage of an initial preventive physical exam, and diabetes and cardiovascular disease screening tests, to ensure beneficiaries are taking advantage of these services and getting the care they need to better manage their diabetes.

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