# Presentation: 531195

## Allen M. SpiegelDirector

**National Institute of**
**Diabetes & Digestive &**
**Kidney Diseases**

**Primary Prevention of Type 2 Diabetes**

## Estimated Growth in Type 2 Diabetes and US Population From 2000-2050

**Bagust A, et al. Diabetes 50, Suppl 2 A205, 2001**

## Rationale for a Prevention Trial

**The prevalence of type 2 diabetes is increasing in epidemic proportions throughout the world**
**Once type 2 diabetes develops, it is difficult to treat**
**Prevention of type 2 diabetes would result in a significant reduction in human and economic costs**

## The Diabetes Prevention Program  A Randomized Clinical Trial to Prevent Type 2 Diabetes in Persons at High Risk 

- Sponsored by the NIH- NIDDK, NIA, NICHD, NCMHD, OBSSR, ORWH, and NCRR and IHS, CDC, ADA
- Corporate Support from Bristol-Myers Squibb, Warner-Lambert

## Stages in the History of 

**Preclinical **
**    ****state**

**Normal**

**IGT**

**Clinical **
**disease**

**Type 2**
**Diabetes**

**Disability**
**   ****Death**

**Complications**

**Complications**

** ****Primary                 Secondary       Tertiary**
**prevention             prevention     prevention**

**Stages in the History of **
**Type 2 Diabetes**

**“****Pre-diabetes”**

## Study Interventions

**Eligible participants**
**Randomized**
**Standard lifestyle recommendations**

**Intensive **
**Lifestyle**
**(n = 1079)**

**Metformin**
**(n = 1073)**

**Placebo**
**(n = 1082)**

## Diabetes Incidence Rates by Race-Ethnicity

## Slide 8

**Notes:**
Thank you, Dr. Gavin. 
As we heard earlier the morning, the science is clear: Diabetes can be delayed or prevented. 
Yes, diabetes is serious, common, costly, and controllable.  But it is now a disease that we now know can be delayed or prevented through modest lifestyle changes. 
This is great news – especially for the more than 16 million Americans that have pre-diabetes. 
This is a message they need to hear. In order to get this good news out to the public, the National Diabetes Education program has designed the Small Steps. Big Rewards. Prevent type 2 diabetes campaign.

## To create awareness of the following:

Type 2 diabetes can be delayed or prevented in people with pre-diabetes
Who is at risk for pre-diabetes
The term pre-diabetes
Indications for testing patients at risk for pre-diabetes
What providers can do to help their patients with pre-diabetes

**To create awareness of the following:**
**Type 2 diabetes can be delayed or prevented in people with pre-diabetes**
**Who is at risk for pre-diabetes**
**The term pre-diabetes**
**Indications for testing patients at risk for pre-diabetes**
**What providers can do to help their patients with pre-diabetes**

**Notes:**
The campaign has several goals. 
First and foremost, we need to educate the public about prevention. Type 2 diabetes can be delayed or prevented in people with pre-diabetes. 
In order to get the message out to these people, we need to identify them. This campaign will seek to educate the public about who is at risk for pre-diabetes. What are the risk factors?
We keep talking about pre-diabetes, but the term is a new one that not everyone understands. As we seek out those at risk, we need to educate the public, health care professionals and the media about the term pre-diabetes. 
If our public awareness campaign is as successful as we hope, and I’m sure with the help of everyone in this room today that it will be, more people than ever will be asking their health care provider about their risk for pre-diabetes. We need to help the health care provider by providing information about testing and testing for pre-diabetes. And, once they’ve identified patients at risk, we need to provide them with the tools to treat those patients.   

## For Health Care Providers: 

**For Health Care Providers: **
**GAME PLAN Toolkit**

**Notes:**
As we have heard, the Diabetes Prevention Program gave us scientific proof that diabetes can be delayed or prevented. The DPP proved that prevention was possible.  
The DPP, however, was a structured, clinical trial that had more resources and a single focus, different from the daily experience of health care professionals. 
In order to take the lessons learned from the DPP and translate them into materials for health care professionals and people at risk, the National Diabetes Education Program designed a toolkit for health care providers: Small Steps. Big Rewards: Your GAME PLAN for Preventing Type 2 Diabetes. 

## Post-DPP Translation ResearchNeed to translate recent advances in the prevention of type 2 diabetes into clinical practice for individuals and communities at risk, especially in underserved and minority populations

**Two initiatives to stimulate research:**
**Planning grants (R34):  PAR 03-060**
**Clinical trials (R18):  PA 02-153**

## STOPP—T2DStudies to Treat or Prevent Pediatric Type 2 Diabetes

**Prevention Sites – Houston, Orange County, CA,   North Carolina**
**Prevention Trial**
**Population-based intervention**
**Physical education**
**Food service**
**Behavior**
**School as unit of randomization**
**Follow 6****th**** grade cohort for 3 years**
**Possible outcome measure:  Percentage of 8****th**** graders with        pre-diabetes, determined by OGTT**
**Timeline**
**Winter 2003 – OGTT Pilot**
**Fall 2003 – Intervention Pilots**
**Fall 2004 – Full-scale Intervention**

## Stages in the Natural History of Diabetes: 

**Normal**

**IGT**

**Diabetes**

**Disability**
**   ****Death**

**Complications**

**Stages in the Natural History of Diabetes:**** **
**Prevention Is Possible**

**   ****Primary                       Secondary    Tertiary**
**   ****prevention                  prevention   prevention**

**“****Pre-Diabetes”**

**Notes:**
How do we address this national epidemic?  The U.S. investment in NIH-supported research has given scientists a much more complete understanding of the progression of diabetes, its stages, and effective treatment for the 16 million people who already have type 2 diabetes (yellow). 
However, while the treatments for the complications of diabetes (pink) are improving, our goal is to eliminate these  complications, which include some of the most serious known to mankind:  blindness, amputations, kidney failure, heart attack and stroke.
Fortunately, we have found through research that there is a “pre-diabetic” state, (in blue) which we call IGT or impaired glucose tolerance.  An estimated 20 million Americans have IGT and are poised to develop type 2, unless we can intervene to stop the epidemic.