Conferences

CDC Faculty

Course Director

K.M. Venkat Narayan, MD, MPH, MBA

Program Assistant

Susana Moran, BS

Eligibility

A maximum of 40 participants will be selected to participate. Participants must have a background in at least one of the following: public health higher education, a U.S. state diabetes prevention and control program, or programs overseas, such as the World Health Organization or similar experience.

The minimum eligibility requirement is a master's of public health degree or equivalent or at least two years experience in public health research within the previous five years. Please provide some evidence (courses, published papers) of research training in a relevant discipline, such as epidemiology, statistics, health services research, health economics, or sociology, or have earned an MD or PhD degree.

Selection Process

The course will be announced through CDC, state diabetes prevention and control programs, American Diabetes Association, World Health Organization, International Diabetes Federation, Association of Schools of Public Health, Association of Teachers of Preventive Medicine, American Public Health Association, and other relevant networks.

Using a standardized application form (Word file - 73 KB), apply before June 30, 2004. Please provide the following as part of the application:

• A 250-word or fewer description on why you wish to attend the course and what you expect to achieve from it

  Confirm the source of funds to cover travel and accommodations, whether it is yourself or your organization. If you have a sponsor (employer or other), provide a letter confirming that financial support will be provided.

  CDC’s Division of Diabetes Translation may be able to offer travel expenses for two qualified candidates, selected strictly on the basis of need. If you need this assistance, please explain the following: 

  1. Why you could not find another source of funds; 
  2. Name other sources you have contacted for funds (provide a letter to confirm); and 
  3. Whether you have approached your employer for support (provide a letter to confirm).
     
• Selection for travel assistance from CDC will be based on the following, but we will give preference to people from developing countries:
  1. Need
  2. Level of qualifications, experience, and seniority
  3. Degree of benefit to the person and organization

An independent selection committee will review the applications using objective criteria to select candidates for the course. We will inform candidates by July 12, 2004, whether they have been selected.

Course Goals

• To provide basic subject matter information on diabetes public health and epidemiology
• To provide basic training in diabetes translation research and health economics
• To create a national and international network of collaborators who have at least basic training in translation research and health economics

Course Objectives

Familiarize students with

• Diabetes epidemiology
• Standardized measurement(s) of the public health burden of diabetes
• The rationale, concept, and methods used in translation research, health economics, social and behavioral research, and community-based interventions and programs.
• Help students develop skills in diabetes public health and translation research.

2003 Agenda

Day 1 (October 20)
Public Health Issues Related to Diabetes

8:45 AM - 9:15 AM | Introduction | Susana Moran

9:30 AM - 10:45 AM | An International Perspective | Edward Gregg, PhD

Objectives

1. Describe and contrast the current and projected burden of diabetes in the United States and worldwide.
2. Summarize and contrast the key factors underlying the diabetes epidemic in the United States and worldwide.
3. Summarize the potential and key barriers, to managing and preventing diabetes worldwide.
4. Describe and contrast potential various public health responses to the diabetes epidemic

Readings

• King H, Aubert R, Herman W. Global burden of diabetes, 1995-2025: prevalence, numerical estimates, and projections. Diabetes Care 1998;21(9):1414-1431.
• Narayan KM, Gregg EW, Fagot-Campagna A, Engelgau MM, Vinicor F. Diabetes–a common, growing, serious, costly, and potentially preventable public health problem. Diabetes Research in Clinical Practice 2000;50:S77-84.
• Zimmet Paul, Alberti KGMM, Shaw J. Global and societal implications of the diabetes epidemic. Nature 2001;414:782-787.

11:00 AM - 12:00 PM | Public Health Surveillance in the United States | Stephanie Benjamin and Linda Geiss

Objectives

1. Discuss the many data sources used for the surveillance of diabetes.
2. Describe the challenges associated with diabetes surveillance.
3. Present the different topics addressed in CDC's surveillance system.
4. Describe recent trends in the prevalence of diabetes and its complications, diabetes mortality, and diabetes-related preventive care practices.

Readings

• CDC. Preventive-care practices among persons with diabetes --- United States, 1995 and 2001. MMWR 2002;51:965-69. http://www.cdc.gov/mmwr/PDF/wk/mm5143.pdf
• Mokdad AH, Ford ES, Bowman BA, Nelson DE, Engelgau MM, Vinicor F, Marks JS. Diabetes trends in the United States:1990-1998. Diabetes Care 2000;23(9):1278-1283.
• Tierney EF, Geiss LS, Engelgau MM, Thompson TJ, Schaubert D, Shireley LA, Vukelic PJ, McDonough SL. Population-based estimates of mortality associated with diabetes: use of a death certificate check box in North Dakota. American Journal of Public Health 2001;91(1):84-92.
  

1:15 PM - 2:15 PM | Modifiable Risk Factors | Rodolfo Valdez

Objectives

1. To understand the concept of risk factors.
2. To identify modifiable risk factors.
3. To recognize the complex interaction between risk factors and chronic disease.
4. To know the most important risk factors for diabetes.

Readings

• Hu FB, et al. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med. 2001;345:790-797.

2:30 PM - 3:30 PM | Primary Prevention | David Williamson

Objectives

1. Discuss findings of major randomized clinical trials of primary prevention of type 2 diabetes and current research in progress.
2. Review current understanding of risk factors for type 2 diabetes in populations and individuals, and major approaches for intervention.
3. Develop research priorities for translating primary prevention into community and public health settings.
4. Explore potential approaches for evaluating the public health impact of Explore potential approaches for evaluating the public health impact of primary prevention programs.

Readings

• Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine 2002;346(6):393-403.
• Pan XR, Li GW, Hu YH, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance: the Da Qing IGT and diabetes study. Diabetes Care 1997;20:537-544.

Public Health Issues Related to Diabetes
Lecture

3:45 PM -5:00 PM | Screening for Diabetes and Pre-Diabetes | Michael Engelgau

Objectives

1. Learn the criteria required for screening to be an appropriate PH activity.
2. Learn about the various types of screening tests and their performances.
3. Learn about the evidence supporting screening.
4. Learn about national policies for diabetes screening.

Reading

• Engelgau MM, Narayan KM, Herman WH. Screening for type 2 diabetes (Technical Review). Diabetes Care 2000;23:1563-80.

Day 2 (October 21)

Lectures

9:00 AM - 10:15 AM | Diabetes in Children | Pina Imperatore

Objectives

1. Learn of different forms of diabetes that affect children.
2. Learn diabetes burden and its complications in youth. 
3. Learn about risk factors of diabetes in youth, with emphasis in type 2 diabetes. 
4. Learn about surveillance strategies for diabetes in youth.

Readings

• American Diabetes Association. Type 2 diabetes in children and adolescents. Diabetes Care 2000 Mar;23(3):381-9.
• Dabelea D, Hanson RL, Bennett PH, Roumain J, Knowler WC, Pettitt DL. Increasing prevalence of type 2 diabetes in American Indian children. Diabetologia 1998;41:904-910.
• Gale EAM. The rise of childhood type 1 diabetes in the 20th century. Diabetes Care 2002;51:3353-3361.
• Karcoven M, Viik-Kajander M, Moltchanova E, Libman I, LaPorte R, Tuomilehto J. Incidence of childhood diabetes worldwide. Diabetes Care 2000;23:1516-1526.
• Onkamo P, Väänäen S, Karvonen M, Tuomilehto J. Worldwide increase in incidence of type I diabetes--the analysis of the data on published incidence trends. Diabetologia 1999;42(12):1395-403.

Recommended Reading:

• Wilkin TJ. The "accelerator hypothesis: weight gain as the missing link between type I and type II diabetes. Diabetologia 2001;44:914-922.

10:30 AM - 12:00 PM | Diabetes Complications | Venkat Narayan

Objectives

1. To describe the epidemiology of the major complications of diabetes.
2. To summarize the interventions available to prevent diabetes complications.

Readings

• Keen H, Clark C, Laakso M. Reducing the burden of diabetes: managing cardiovascular disease. Diabetes/Metabolism Research Reviews 1999;15:186-196.
• U.K Prospective Diabetes Study Group. Intensive blood-glucose control with sulphonureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998;352:837-53.

1:00 PM - 2:30 PM | Quality-of-Care Measures | Jinan Saaddine

Objectives

1. What is quality, and health care quality components?
2. How can we measure quality (traditional measures of diabetes quality of care, and guidelines vs. quality improvement measures)?
3. Diabetes Quality Improvement Project (DQIP).
4. The need to measure quality and at what level.

Readings

• Fleming BB, Greenfield S, Engelgau MM, Pogach L, Clauser SB, Parrott MA, for the DQIP group. The Diabetes Quality Improvement Project: moving science into health policy to gain an edge on the diabetes epidemic. Diabetes Care 2001;24:1815-1820.
• Saaddine JB, Engelagau MM, Beckles GL, Gregg EW, Thompson TJ, Narayan KM. A diabetes report card for the United States: quality of care in the 1990’s. Annals of Internal Medicine 2002;136:565-574.

2:30 PM - 3:45 PM | Complexity and Change | Venkat Narayan

Objectives

1. To become familiar with the concept of complexity.
2. To assess how to operate within complex systems.
3. To appreciate how change happens in complex systems.
4. To understand how to develop programs taking into account complexity and change.

Readings

• British Medical Journal. 2001;323:625-8
• Narayan KMV, Gregg EW, Engelgau MM, Moore B, Thompson TJ, Williamson DF, Vinicor F. Translation research for chronic disease: the case of diabetes. Diabetes Care 2000;23:1794-8.

Translation Research
Lecture

4:00 PM - 5:00 PM | Introduction | Venkat Narayan

Objectives

1. To describe the gaps between knowledge and implementation of diabetes care.
2. To describe barriers to implementation.
3. To describe the concept of translation research and its challenge.

Day 3 (October 22)
Translation Research (continued)
Lectures

9:00 AM - 9:45 AM | Review of Interventions to Improve Care | Carol Mangione

Objectives

1. To familiarize the participants with the types of interventions commonly used by health care systems to improve the process and outcomes of diabetes care.
2. To describe what is known about the effectiveness of various system-level interventions designed to improve the quality and outcomes of diabetes care.
3. To provide an introduction to the strengths and weaknesses of various study designs that can be used to evaluate the effectiveness of system-level interventions.
4. To familiarize the participants with early findings from TRIAD.

Readings

• Renders CM, Valk GD, Griffin SJ, Wagner EH, Jacques TE, Assendelft WJJ. Interventions to improve the management of diabetes in primary care, outpatient, and community settings. Diabetes Care 2001;24:1821-1833.

10:00 AM - 10:45 AM | Importance of Measuring Social Position | Arleen F. Brown

Objectives

1. To be able to define social position.
2. To identify common measures of social position that is useful in translational research.
3. To understand the relationships between social position and health for persons with diabetes and how this may differ in different health care settings.
4. To understand the ways that social position may influence the design, implementation and results of translational research in diabetes care.

Readings

• House JS, Williams DR. Understanding and reducing socioeconomic and racial/ethnic disparities in health. IOM Report "Promoting Health." 81-124.

Workshops

10:45 AM - 12:45 PM | Designing Translation Research Projects | Carol Mangione and Arleen F. Brown

Objectives

1. To provide a basic understanding of the strengths and weaknesses of various study design options for conducting translational research.
2. To help participants determine the feasibility of studying the translation of specific new knowledge to real world settings.
3. To provide practical advice on the development of research questions. Participants should bring topics and their ideas about settings where they might want to conduct translational research.

2:00 PM - 3:50 PM | Measuring System-Level and Provider-Level Factors | Carol Manigone and Arleen F. Brown

Objectives

1. To gain an understanding of the various levels where this information can be measured (health plan, provider group, provider, and patient).
2. To learn about the potential data sources and their strengths and weaknesses for the measurement of system and provider level factors (key informant, claims data, medical record data, or provider and patient surveys).
3. To provide a brief introduction to the analytic challenges of integrating predictors from multiple sources into a unified analysis. Examples will be provided from the TRIAD study.

4:00 PM - 5:00 PM | Statistical Challenges in Translation | Ted Thompson

Objectives

1. Introduce concept of clustered data.
2. Show relevance of clustering to translation research and community based interventions.
3. Demonstrate effect of clustering on sample size calculations.
4. Demonstrate effect of clustering on data analysis.

Day 4 (October 23)
Translation Research and Diabetes Economics
Translation Research - Workshops

9:00 AM - 10:30 AM | Behavioral and Social Science Research | Leonard Jack and Dawn Satterfield

Objectives

1. Discuss use of an ecological model of human behavior to help promote diabetes prevention and control in communities -- linking multiple levels of influence (e.g., individual (intrapersonal); family, friends, peers; health care professionals (interpersonal); health care and other systems (organizational); social networks and norms (community); and local, state, federal policies and laws (public policy).
2. Identify opportunities to improve family-centered intervention design, study participant recruitment, outcome selection, and data reporting.
3. Discuss the rationale for use of qualitative research methods to inform intervention design and data analysis.
4. Discuss the role of protective factors, including cultural buffers (e.g., identity attitudes, enculturation, spiritual coping, storytelling, and traditional health practice) in supporting diabetes prevention and health promotions in communities.

Readings

• Brody G, Leonard JJ, McBride Murry V, Lenders-Potts M, Liburd L. Heuristic model linking contextual processes to self-management in African American adults with type 2 diabetes. The Diabetes Educator 2001;27(5):685-693.
• Leonard, JJ. Diabetes self-management education research – an international review of interventions methods, theories, community partnerships and outcomes. Disease Manage Health Outcomes 2003;11(7):415-428.

Recommended Readings

• American Association of Diabetes Educators. Cultural sensitivity: definition, application, and recommendation for diabetes educators. The Diabetes Educator 2002;28(6):922-927
  - Leonard JJ. Influence of the Environmental Context on Diabetes Self-Management: A Rationale for Developing a New Research Paradigm in Diabetes Education. The Diabetes Educator 1999;25(5):775-790.

10:40 AM- 12:00 PM Vision for Diabetes Public Health Frank Vinicor

Objectives

1. Establish criteria wherein a health care system can be evaluated as to “quality.”
2. Define “Public Health.”
3. Identify at least 3 differences between clinical and public health.
4. Describe methodologies to balance clinical and public health approaches to diabetes prevention and control.

Readings

• Berwick DW. Disseminating innovations in health care. JAMA 2003;289(15):1969-1975.
• Callahan D. False Hopes. Creating a Sustainable Medicine. 25-45.
• Commentary. The Best Health Care System in the World? JAMA. 1992;268(7):916-917.
• Davis D, Evans M, Jaded A, Perrier L, Rath D, Ryan D, Sibbald G, Straus S, Rappolt S, Wowk M, Zwarenstein M. The case for knowledge translation: shortening the journey from evidence to effect. British Medical Journal 2003;327:33-35.
• Norris, Susan et al. Chronic disease management. Disease Manage Outcomes 2003;11(8):488.
• Vinicor F, Rufo K, Murphy D. Diabetes and Public Health in the United States. International Textbook of Diabetes Mellitus, Third Edition. September 2003.

1:00 PM - 2:30 PM | What Makes a Systematic Review Systematic? | Tanya Armour

Objectives

1. To provide an overview of what makes a review systematic.
2. To provide an understanding for how to efficiently locate evidence for a review.
3. To demonstrate certain skills necessary for conducting a systematic review (i.e., forming your research questions, creating a search strategy, managing citations).
4. To provide an understanding of how systematic reviews are presented and to introduce individuals to preferred guidelines available.

Diabetes Economics
Lecture

2:40 PM - 4:00 PM | Introduction | Ping Zhang

Objectives

1. To familiarize students with why economics is important.
2. To familiarize students with the basic concepts of health economics.
3. To briefly describe the main types of economic studies.

Readings

• American Diabetes Association. Economic costs of diabetes in the U.S. in 2002 Diabetes Care 26:917-932.
• Diabetes Prevention Program Research Group. Within-Trial Cost-Effectiveness of Lifestyle Intervention or Metformin for the Primary Prevention of Type 2 Diabetes. Diabetes Care 2003;26:2518-2523.
• CDC Diabetes Cost-effectiveness Study Group. Cost-effectiveness of intensive glycemic control, intensified hypertension control, and serum cholesterol level reduction for type 2 diabetes. JAMA 2002;287(19):2542-51.

Recommended Books

• Drummond MF, O'Brien B, Torrance GW, Greg SL. Methods for the Economic Evaluation of Health Care Programs. Second edition. Oxford University Press, 1997.
• Gold MR., Siegel JE, Russell LB, Weinstein MC (eds.). Cost-Effectiveness in Health and Medicine. Oxford University Press: New York, 1996.
• Haddix AC, Teutsch SM, Corso PS (eds.). Prevention Effectiveness: A Guide to Decision Analysis and Economic Evaluation. Oxford University Press: New York, 2003.

Special Session

4:15 PM - 6:00 PM | Scientific Writing (Attendance is Optional) | Venkat Narayan and Edward Gregg

Objectives

1. To become familiar with effective scientific writing.
2. To become familiar with efficient ways of writing scientific papers.
3. To become familiar with effective ways of marketing scientific paper journals.

Day 5 (October 24)
Diabetes Economics and Community-Based and System Interventions
Diabetes Economics - Workshops

9:00 AM - 11:00 AM | Measuring Costs and Benefits | Ping Zhang and Michael Engelgau

Objectives

1. Basic concepts of economic evaluation.
2. Economic evaluation methods commonly used in health and medicine.
3. How to measure costs and health benefits in an intervention.
4. How to apply economic evaluation methods to diabetes and diabetes care.

11:10 AM - 1:00 PM | Model Demonstration | Ping Zhang and Steve Sorensen

Objectives

1. Importance of using computer models for economic evaluations.
2. Strengths and limitations of using computer models for economic evaluations.
3. General model structure of the CDC diabetes cost-effectiveness model.
4. How to use the CDC diabetes cost-effectiveness model for evaluating a diabetes intervention.

Community-Based and System Interventions
Lecture

2:00 PM - 3:00 PM | Putting It All Together: Public Health Programs | Dara Murphy

Objectives

1. Relevant issues and challenges in designing and implementing a chronic disease prevention public health program will be described and explored.
2. Effective tools and processes for ongoing program development will be reviewed.
3. The national diabetes prevention and control program will be used as an example to explore concepts in public health program design and development.

Readings

• Kindig D, Stoddart G. What is Population Health? American Journal of Public Health 2003;93(3):380-383.
• Halverson PK. Embracing the strength of the public health system: why strong government public health agencies are vitally necessary but insufficient. Journal of Public Management Practice 2002;8(1):98-100.
• McKinlay JB, Marceau LD. To boldly go… American Journal of Public Health. 2000;90(1):25-33.

Workshop

3:10 PM - 5:00 PM | Program Evaluation and Evaluation Research | Cindy Clark and Desmond Williams

Objectives

1. Increase knowledge of evaluation techniques used in community-based programs.
2. Increase understanding of the different types of evaluation and their appropriate use and benefits.
3. Increase familiarity with the CDC evaluation framework for program  evaluation.
4. Develop skills to design an evaluation plan using the skills and concepts reviewed during the workshop.

Recommended Readings

• Centers for Disease Control and Prevention. Framework for program evaluation in public health. MMWR 1999;48(No. RR-11).
• Goodman RM, Liburd LC, Green-Phillips A. The formation of a complex community program for diabetes control: lessons learned from a case study of Project DIRECT. Journal of Public Health Management Practice 2001;7(3):19-29.