Welcome: Dr. Richard Eastman
Dr. Richard Eastman welcomed attendees to this DMICC meeting on the National Diabetes Education Program (NDEP) and its current campaign "Control Your Diabetes. For Life." Dr. Eastman then introduced Dr. Frank Vinicor, who presented a history of the NDEP.
History of the NDEP: Dr. Frank Vinicor
In the mid-1970s, the National Commission on Diabetes was formed and laid the groundwork that resulted in the passage of the National Diabetes Act. This Act established both a national program to coordinate the Federal Government's efforts with respect to diabetes and the National Diabetes Advisory Board (NDAB). The role of the NDAB, which comprised approximately 30 members from Federal agencies and ex-officio representatives, was to map out the national strategy to address the problem of diabetes in this country.
In 1987, the NDAB identified a need for a national program on diabetes equivalent to that on cholesterol (National Cholesterol Education Program) and high blood pressure (National High Blood Pressure Education Program). Although the NDAB disbanded in the mid-1990s, efforts toward the development of the NDEP continued. The responsibility for coordinating this program was jointly assumed by the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH). The program began with a budget of approximately $1-1.5 million.
Dr. Eastman then called on Dr. Charles Wells, the DMICC Executive Secretary, to introduce the NIH and CDC NDEP directors, Ms. Joanne Gallivan and Ms. Faye Wong, who presented an overview of the NDEP and its campaigns.
Partners and Campaigns of the NDEP: Ms. Joanne Gallivan
The NDEP is a federally sponsored program that addresses the increasing prevalence and incidence of diabetes and involves the NIDDK/NIH, CDC, and approximately 150 public and private organizations. Program planning was begun in 1995 and considered the recommendations of the DMICC and others. The goal of the program is to reduce the suffering, illnesses, complications, and death associated with diabetes and its complications. The NDEP target audiences include people with diabetes mellitus and their families; health care providers, payers, and purchasers of health care; and the general public, specifically those at risk and those undiagnosed. The message the NDEP seeks to convey is that diabetes is serious, common, and costly, but controllable.
Organizational Structure of the NDEP
The Executive Committee, Steering Committee, and the Partnership Network comprise the NDEP organizational structure. Ad Hoc Work Groups work in conjunction with the Steering Committee and Partnership Network to address priority issues and activities identified by the Steering Committee.
Executive Committee. The committee focuses on program vision, goals, objectives, and direction.
Steering Committee. The committee comprises 27 organizations that help in providing program planning, identifying program directions, and setting the program agenda.
Partnership Network. This is the core of the NDEP and comprises about 150 organizations. The network helps to deliver the messages of the NDEP to affected populations and ensure that the messages are appropriate to the targeted communities.
Ad Hoc Work Groups. These groups are made up of representatives of the steering committee and outside organizations and meet to plan and implement individual activities that support the goal and objectives of the NDEP.
The Awareness Campaign
Focusing on specific populations with diabetes, the "Control Your Diabetes. For Life." campaign aims to increase awareness that lowering glucose levels can make a huge difference in quality of life. The primary audience for the campaign is people with diabetes and their families. It is estimated that more than 16 million people have diabetes, of which only two-thirds are aware that they have the disease. The secondary audience is health care providers.
The message of the campaign is that diabetes is a serious illness that can be controlled by eating a proper diet, engaging in more physical exercise, taking medication as prescribed, and testing one's blood sugar levels. This basic message goes into all public service announcements (PSAs) and other materials. Although the umbrella message "Control Your Diabetes. For Life." is used in all campaigns, there are six campaigns tailored for specific minority and special populations: African Americans, Hispanic Americans, Asian Americans and Pacific Islanders, American Indians, general audiences, and senior Medicare beneficiaries. Each campaign has tailored products to reinforce the overall "control" message.
Community Intervention, Health Systems, and Partnership Network of the NDEP: Ms. Faye Wong
Community Intervention and Health Systems
Ms. Wong made two significant points about community influence on the NDEP. First, it was apparent that sending messages about diabetes via the mass media (television, radio, and print) did not reach targeted populations with the needed level of intensity. A better approach would be to reach out to individuals through their communities and through community organizations. To accomplish this, the NDEP needed guidance from those communities and community organizations.
Second, the NDEP planning meetings clearly indicated that the health system in many parts of this country is deficient. Doctors do not spend enough time with their patients to tell them what they need to know to control diabetes. Patients also are not told of allied and other health professionals, such as nurses, dietitians, and diabetes educators, who can provide assistance.
The NDEP planners thus made a decision to address these issues and formed the following five work groups:
NDEP Guiding Principles Work Group. The purpose of this work group is to develop and disseminate guiding principles that represent the essential components of quality diabetes care and treatment. Using guidelines on good diabetes care from different organizations, this group produced a consensus document, Guiding Principles for Diabetes Care, that outlined the components and aspects of good care. One version was prepared for health professionals in both English and Spanish; another version was prepared for consumers.
NDEP Risk Stratification Work Group. The purpose of this work group is to provide patients and health care providers with reasonable estimates of the risk of diabetes-related complications based on hemoglobin A1c levels. This group evaluated hemoglobin A1c levels and the related risk for complications and made this information available to laboratories. The information accompanies laboratory results sent to physicians and indicates the meaning of the results and the risk for complications the patient might have. This information can guide diabetes care and education.
NDEP Team Approach to Care Work Group. This group considered the issue that doctors are trying to do too much in too little time and are not using their colleagues, namely the supporting team. The group developed an NDEP policy statement on the team approach after surveying models currently in use and noting their advantages and disadvantages. The group prepared a draft document that summarizes these findings and a "how to" document to assist physicians and other caregivers in moving toward a team approach. A final document will be prepared that outlines the advantages of a team approach and how to move diabetes care in that direction.
NDEP Business and Managed Care Work Group. This group has been studying the policies of businesses and the managed care plans they offer their employees that adversely affect employees' health care. The group has produced a white paper on its findings and is working on a work-site kit for employers, benefits managers, corporate wellness and health promotion directors, and others.
NDEP HCFA Medicare Benefits Work Group. The purpose of this work group is to provide input on the development of Medicare regulations on diabetes and promote the new benefits to health care providers and Medicare beneficiaries in coordination with HCFA.
In addition, the NDEP has three new work groups:
NDEP Children and Adolescents Work Group. Because of an increase in diabetes diagnoses nationwide in children and adolescents, this work group was formed to explore the scope of the problem, what other health professional organizations are doing, and how NDEP can coordinate efforts to disseminate information to health care providers.
NDEP Evaluation Work Group. The purpose of this work group is to develop a practical plan for evaluating the effectiveness and outreach of the NDEP.
NDEP Community Interventions Work Group. The purpose of this group is to help partners and community organizations implement diabetes interventions at the local level
From the onset of the NDEP, partnership has been its core. This partnership model has the NDEP in the middle and coordinating the effort with extensive input from all the partners: the NIH and the CDC, and traditional and nontraditional partners. Early work was carried out by only the traditional partners, namely health care providers, doctors, nurses, and traditional organizations, but it was not sufficient. Partnerships were then sought and established with nontraditional groups, namely, faith communities, churches, minority groups, community-based organizations, and voluntary organizations. Although the traditional partners know the science, treatment, and care of diabetes, the nontraditional partners have the trust of the people and the community.
The purpose of the NDEP is to mobilize a critical mass of public and private sector organizations, at the national, State, and community levels, to partner and collaborate to change the way diabetes is treated. This means (1) changing the focus from treatment of complications after they develop to prevention of complications and early detection and (2) changing the focus of care from the doctor to the patient.
NDEP Campaigns and Work Group Campaign Updates
Ms. Wong discussed the following campaigns and activities of the related work groups.
General Audience Campaign
These NDEP campaigns are directed at people with type 2 diabetes, generally 40 years of age and older, and predominantly deal with control of the disease. The campaigns are designed to reinforce that diabetes is a serious disease and that diabetes care can reduce the risk of complications. PSAs used in the campaigns encourage diabetics to control their own diabetes, to stay alive to enjoy life, and to be around for family, loved ones, and especially grandchildren.
Some PSAs have been criticized because they seemingly placed blame on the patients if they did not respond to treatment, or they suggested that people who were actually controlling their diabetes (type 2) were not doing so.
Work Group Campaign Updates
African American Work Group: Mary Clark
Started in 1997, this group focuses on African Americans with diabetes, in particular those in certain areas of Mississippi and Missouri. Ms. Clark noted that, in these areas, family relationships were supportive and that people were aware of the seriousness of diabetes, although patients found it very hard to eat the right foods at family gatherings.
Using this input, the group produced materials about family ties that emphasize the link between a granddaughter and grandfather (featuring Jackie Robinson, a hero in the African American community) and show that family gatherings are important. This latter PSA emphasizes that people with diabetes want to be around for their families.
The African American Work Group planned their outreach and partnership activities at the partnership network meeting in May 1999. Some highlights follow.
The group exhibited their products at the National Council of Negro Women's National Black Family Reunion meetings held in about eight cities throughout the country.
The group made a presentation to physicians in the Internal Medical Section of the National Medical Association at the Association's national meeting in Las Vegas, Nevada. As one followup, these physicians were given a questionnaire on how the NDEP could help them get the message about diabetes to their patients and other consumers.
The group helped Links, Inc., integrate the NDEP into their National Diabetes Month activities and promotions.
The group made a presentation in partnership with the Statewide Minority Health Coalition and exhibited at the Fourth Annual Health Summit in Tennessee. Dr. Stephanie Perry, an NDEP member, discussed the NDEP at the closing luncheon.
U.S. Department of Agriculture: Dr. Gladys Gary Vaughn
The NDEP is included in the programs of the Department of Agriculture's Health Initiative, which is implemented by the Families, 4-H & Nutrition Unit of the Cooperative State Research, Education and Extension Service (CSREES), the well-established (since 1914) national program that disseminates research-based information designed to improve individual, family, and community well-being. It is through this route that information on diabetes is first disseminated to State extension specialists and county extension faculty, and then to the people, who are made aware of the diabetes campaign and materials.
CSREES is also involved in a special program with the Joslin Diabetes Center in Boston. Joslin has developed a noninvasive method of identifying and detecting diabetes and is working with CSREES to pilot test a partnership model with the State Cooperative Extension programs in Washington and Hawaii. Among the populations targeted are Native Hawaiians and Pacific Islanders and Native Americans, three of the population groups with the highest incidence of diabetes.
Hispanic/Latino Campaign: Dr. Gladys Gary Vaughn for Eliana Loveluck of the National Coalition of Hispanic Health and Human Services Organizations (COSSMHO)
Dr. Vaughn noted that the NDEP uses a social marketing approach to develop the campaigns. This approach requires that planners understand the audience and what their beliefs and cultural issues are and that they tailor the messages and presentations to these audiences.
In the "Control Your Diabetes. For Life" campaign, planners learned that Hispanics and Latinos have a fatalistic attitude toward diabetes. Therefore, the campaign compares diabetes, which can be controlled, with something that cannot be controlled, such as nature, thunder and lightning, or rain and snow. Two programs,"Thunder and Lightning" and "Rain and Snow," offered in English and Spanish, have been very well received by the Spanish-language media and have won two awards. The campaign has been embraced by partners throughout the country and has been featured in a variety of events, including the annual meeting of the National Council of La Raza and the second annual 1999 Diabetes Education Conference.
Asian American/Pacific Islander Campaign: Jeff Caballero
Mr. Caballero, the interim executive director of the Association of Asian Pacific Community Health Organizations (AAPCHO), said that AAPCHO is a national association of 14 community health clinics that provides technical assistance to community-based organizations serving Asians and Pacific Islanders. Speaking for AAPCHO and these other organizations, Mr. Caballero recognized the NDEP for what it had set out to do, notably to reinforce that the patient has an active role to play in his or her treatment for diabetes and to provide resources to patients with which to work. He also described the diversity of the Asian American/Pacific Islander Campaign work group (more than eight Asian ethnic groups and three Pacific Islander groups), which made strategic planning challenging, in particular the organization of telephone conferences across 10 different time zones.
The campaign began in March 1998 after having considered several specific challenges:
The composition of the audiences. Because there were more than 65 recognized languages to consider, as well as continuous growth of the communities through immigration, the strategic planning group decided to work primarily with the largest population group and the populations that had the highest prevalence of diabetes.
The generic message that would reach all communities and the targeted audience. The planning group agreed to direct the message to all people with type 2 diabetes.
The scattered populations. The need for focus groups was evident after considering that the various target population groups were spread throughout the country.
The planning group identified eight populations for focus groups: Chinese, Filipino, Korean, Asian Indian/Pakistani, Vietnamese, Cambodian, Hawaiian, and Samoan. The PSAs were to be presented mainly in English, but with the faces of Asian Americans and Pacific Islanders on them, and would reinforce the seriousness of diabetes.
The campaign to reach the Asian American media in Washington State started in September 1999 and the campaign to reach Asian Americans and Pacific Islanders is to start in November 1999. The partners in the NDEP and the Washington Diabetes Control Program will coordinate outreach to both the English- and Asian-language media to penetrate the Asian American and Pacific Islander communities. The partners will work with community leaders to help prepare them to respond to the media and to recruit media in their own communities to publicize diabetes. This is another example of a partnership between the NDEP and the community partners.
American Indian Campaign: Ms. Lorraine Valdez
Ms. Valdez, who works with the Indian Health Service (IHS), in the Headquarters Office of the Diabetes Program in Albuquerque, New Mexico, has been a member of the American Indian NDEP subcommittee since its inception. This committee has been aware of and has worked to control the epidemic of diabetes among American Indians for many years.
The American Indian Campaign on diabetes considered several factors, including:
American Indians have diabetes in epidemic proportions. In certain tribes, more than 50 percent of members over the age of 40 have type 2 diabetes, and diabetes is on the increase among children as young as 5 years of age.
An attitude of fatalism is pervasive among these populations, who believe that no matter what they do they will develop diabetes anyway.
Because 550 federally recognized tribes are considered sovereign nations within the United States and many other tribes are trying to regain Federal recognition, many different languages and cultural perspectives, as well as approaches to life, must be considered in developing messages about diabetes for these various communities.
In addition, the campaign planners recognized that messages had to be developed that could be used across the country, in cities, and on reservations; that targeting communities and their tribal leaders was as necessary as targeting individuals with diabetes and their families; and that taking into account the diversity of health care providers figured into successful treatment and control of diabetes.
The PSAs not only encourage patients to participate in their own health care and follow a healthy lifestyle but also reinforce that individuals need not have or can delay the onset of diabetes and that prevention is possible. The radio PSA was developed to reach those in the targeted population who might not have a television. The campaign's written materials are in English because many of the Indian languages are not written down and because of the difficulty in producing written material in more that a few languages. The tribes can take these materials, tailor them to appeal to their audiences, and integrate them into other programs. Because faces are important in representing the different tribal groups, most print materials present a variety of faces. Young, old, and in-between are represented to indicate that diabetes affects all age groups within communities.
The campaign materials have been displayed or distributed at numerous conferences and meetings, such as the large (more than 1,000 participants) Diabetes and American Indian Communities Conference that was held in late October in Albuquerque, New Mexico, to showcase the latest research related to diabetes, the IHS's diabetes clearinghouse and health programs, and tribal health service and urban Indian health programs.
Materials also have been provided to minority journalist and media organizations with a Native American component and to individuals who have diabetes. In addition, the 1999 summer issue of Native Peoples Magazine contained a 3-page article written by Dr. Yvette Roubideaux on diabetes among Indians. The article mentioned the activity of the NDEP and the American Indian subcommittee.
Health Care Financing Administration (HCFA) Campaign: Ms. Joanne Gallivan
In 1997, legislation was passed that extended Medicare benefits to include diabetes equipment, supplies, and education. The NDEP has been working with HCFA, which has a cooperative agreement with NIDDK, to develop a campaign to promote HCFA's extended diabetes benefits for equipment and supplies. The education component has not been worked on because regulations have not been finalized. Medicare messages have been incorporated into "Control Your Diabetes. For Life" campaigns, and PSAs have been prepared in both English and Spanish. The PSAs state that Medicare will help beneficiaries who have diabetes pay for the equipment and the supplies they need to test their blood sugar, as well as offer an 800 number for more information.
This campaign is a good example of a local partnership--with HCFA and WJLA-TV, in the Washington, D.C., area, and Safeway stores--that can be expanded across the country. HCFA also is involved in outreach activities with organizations such as the AARP, National Council of La Raza, and National Association of Community Health Centers to promote the campaign.
Agency Updates: The NDEP and Other Diabetes Activities
After the session break, Dr. Wells opened the discussions of agency updates.
Veterans Health Affairs (VHA): Dr. Leonard M. Pogach
Dr. Pogach, National Program Director, Diabetes, VHA, congratulated the NDEP on the quality and depth of its materials and said that he would see that they are appropriately placed in the VHA's local treatment facilities. He then proposed that the DMICC focus in part on the Federal response to the Diabetes Quality Improvement Project (DQIP). The objective is to establish ongoing coordination and a mechanism for evaluation and dissemination of mutual efforts, in collaboration with other Federal efforts. He presented several reasons for this strategy.
First, the Department of Health and Human Services (DHHS) supports DQIP. DHHS Secretary Donna Shalala concurred with the adoption of DQIP across the Federal sector as recommended at the September 21, 1999, meeting of the Quality Improvement Coordinating Task Force, established by Presidential Executive Order. The Agency for Health Care Policy and Research (AHCPR) has been named to follow up on the responses of the various agencies.
A second reason is that the implementation of DQIP will affect lives and expenditures. Together, the VHA, Department of Defense, IHS, HRSA, and federally qualified plans provide direct ongoing diabetes care for more than an estimated 1 million Americans with diabetes, and HCFA assumes a significant financial burden for diabetes care in America.
A third reason is that a coordinated Federal response will demonstrate leadership.
Dr. Pogach then discussed the impact DQIP would have on diabetes care and how it would improve the quality of life for those with diabetes, with the expectation of eventual decreases in end stage complications and mortality. He also discussed how to measure the impact of DQIP and how the project can benefit the Federal cause. Dr. Pogach offered that a tie-in could be established with the NDEP to improve dissemination of information to health care providers. Also, the Federal Government should continue to have a leadership role in research.
As an action plan, it was recommended that the DMICC spend a significant portion of the next meeting on DQIP.
National Institute of Nursing Research: Dr. Nell Armstrong
The Institute has been studying self-management activities and behavior, as well as responses, related to diabetes management for many years. With the renewed interest in diabetes--Federal and other--and the potential for more resources, the Institute's 5-year plan can focus on all aspects of diabetes management related to nursing practice and client care. In the year 2000, the focus will be on self-management among all persons with diabetes. In 2001, the focus will be on diabetes self-management in minority populations. Other plans include work on health disparity issues and with special populations who have not had full access to care.
National Center for Health Statistics (NCHS): Dr. Mark Eberhardt
Dr. Eberhardt stated that the NCHS is not directly involved with the NDEP but does provide a large amount of the statistical information that ultimately is used in the program. For example, the next National Health and Nutrition Examination Survey (NHANES) will include information about glycosylated hemoglobin, fasting glucose, fasting insulin and C-peptide, diabetes-related morbidity, and, for the first time, peripheral neuropathy and peripheral vascular disease. Also, the second Longitudinal Study of Aging (LSOAII) in collaboration with the National Institute on Aging was conducted as a followup questionnaire on functional status in people who in 1994 were 70 and older and had participated in the National Health Interview Survey. Such collaboration provides ongoing data on how diabetes affects people's lives in terms of functional status, as well as a baseline of who does better or worse. The NCHS also has worked with HCFA on a linked data file with colleagues from NIDDK and the Division of Diabetes Translation in CDC. NHANES II participants were linked with those who developed end-stage renal disease. This longitudinal followup will provide data on the factors that have resulted in end-stage renal disease among people with diabetes. Some findings have already started to come out, and that data set will be available at the NCHS Data Center for anyone interested in using it for additional research.
National Institute for Child Health and Human Development (NICHD): Dr. Gilman Grave
Dr. Grave stated that he enjoyed hearing about the new activities in diabetes education and that the advertising material content in videos made him realize how important it is to inject more education activities into his Institute, which has no mandate for diabetes education activities. He announced that the NICHD will provide $10 million over the next 5 years to fund a project to enroll 25,000 pregnant women, early in their pregnancy, to detect gestational diabetes. (Worldwide, 4 centers in the United States and 12 centers abroad are studying gestational diabetes.) Dr. Grave said it would be ideal to draft an educational component into this project because of the large number of participants and the expected occurrence of gestational diabetes among 2-3 percent of these women. In addition, about one-half of this 2-3 percent will develop type 2 diabetes within 15 years of their pregnancy.
Health Resources and Services Administration (HRSA): Ms. Rita Goodman
HRSA, in partnership with the Institute for Health Care Improvement, the CDC, and the Group Health Cooperative of Puget Sound, implemented a chronic care model for people with diabetes in approximately 90 of the Bureau of Primary Health Care- and HRSA-funded health centers. The work began in January 1999 with three learning sessions for teams from health centers that have been collaborating with the State Diabetes Control Programs. Areas of concentration included creating and enrolling patients in a diabetic registry at each of the health centers, patient self-management, glycemic control, and prevention of cardiac and microvascular complications. Approximately 7,000 patients are enrolled in registries and are actively managed. Four health centers will be featured for excellence in patient self-management, decision support for clinicians, practice redesign that includes implementation of group visits, a culturally specific diabetes empowerment educational program, and a systemwide improvement in a health care HMO. This current collaborative learning experience will end in December 1999, but the centers will continue to work on core measures.
Another 125 health centers will begin to work on implementing the chronic health care model for diabetes, with a kickoff meeting in January 2000. The NDEP should disseminate the related materials to all of the health centers as soon as possible.
National Institute of Dental and Craniofacial Research (NIDCR): Dr. Patricia Bryant
Dr. Bryant stated that her group is attending the meeting more to learn than to report and would leave with a number of useful ideas. She noted that they have a very strong interest in using the dental office to provide health education and to allow opportunities for screening and reinforcement of healthy behaviors. Dr. Bryant said that some initiatives have been approved by NIDCR's advisory council that relate to behavioral and health promotion research and will enhance dentists' awareness of the impact of diabetes on oral complications, periodontal disease, and early tooth loss.
Message from the DMICC Chair: Dr. Richard Eastman
Dr. Eastman talked about Fiscal Year (FY) 2000 as it relates to the congressionally mandated working group for diabetes research, which met during the past year and formulated a comprehensive research plan to address the issue of diabetes for the NIH. In June 1999, Dr. Phillip Gorden asked what the Institutes were planning to do in the area of diabetes that would be new for FY2000, and Dr. Eastman alerted the Institutes to finalize their lists of initiatives for 2000 in response to the Diabetes Research Working Group plan.
Centers for Disease Control and Prevention: Dr. Frank Vinicor
Dr. Vinicor began by providing an overview of CDC's functions in the public health arena in diabetes related primarily to health surveillance activities in diabetes, health services research, and support of State health departments.
In the area of surveillance, programs have been developed for specific racial and ethnic groups with an increased number of quality measures, not just numbers, concerning who has a condition or complication. One area of interest is type 2 diabetes in youth because of the need for broader population-based surveillance.
In the area of health services research, Dr. Vinicor cited two important activities. The first is a major new project called TRIAD--Translating Research Into Action for Diabetes. At a minimum, this is a 5-year project, with 6 leading managed care organizations, that is evaluating the structure of these organizations and how that structure assists or impedes such factors as better practice behaviors.
The second activity is a review of the relationship between cardiovascular disease and diabetes. This also is a multicenter study involving the CDC and the NIH, specifically the National Heart, Lung, and Blood Institute (NHLBI) and NIDDK.
In the area of supporting State health departments, the CDC diabetes prevention control program provides support for State-based diabetes control programs in all 50 States and territories to develop or expand diabetes control efforts, with additional funding for selected States to conduct comprehensive statewide control efforts. These efforts, in a sense, have created a national program.
Dr. Vinicor then described how the laboratory at CDC will be upgraded for improvement in the area of diabetes; approximately $3 million a year will be allocated jointly by CDC and NIH for this effort. The laboratory will focus primarily on three areas, the first of which is the prevention of type 1 diabetes. A second focus of the laboratory will be the quality-control issues that are relevant to A1c measurements. In addition, staff will consolidate all of the in-house NHANES samples and set up a better system of storing them for subsequent use, particularly for future work related to diabetes.
Next, Dr. Wells invited anyone else who wished to add something to the session to speak.
Health Resources and Services Administration: Ms. Sharley Chen, Director, Lower Extremity Amputation Prevention (LEAP) Program, BPHC
Ms. Chen acknowledged several current and future partners involved with LEAP, such as the American Podiatric Medical Association, the American Pharmaceutical Association, the Congress of National Black Churches, Atlantic Footcare, and Wal-Mart. Atlantic Footcare is working in partnership with Wal-Mart to begin a program that will provide appropriate footwear and orthotic insoles to indigent individuals who have diabetic neuropathy. Temple University's Podiatry Clinic, in inner-city Philadelphia, will participate in the initial pilot.
National Heart, Lung, and Blood Institute: Ms. Eileen Newma
Ms. Newman said that because diabetes is a risk factor for heart disease, several of NHLBI's heart disease prevention initiatives relate to diabetes. The Institute already has developed materials for specific populations, such as Latinos, Native American Indians and Native Alaskans, and African Americans, in conjunction with the National High Blood Pressure Education Program, the National Cholesterol Education Program, and the NHLBI Obesity Education Initiative. She added that NHLBI would be interested in incorporating NDEP materials into NHLBI outreach activities.
Indian Health Service: Ms. Lorraine Valdez
Ms. Valdez stated that in terms of diabetes education, the IHS Diabetes Program focuses on the development of low literacy and easily translatable educational materials. The program also seeks to expand the partnerships that the IHS already has in place.
Ms. Valdez noted that the IHS has adapted several NIDDK publications for use in the diabetes program. For example, the pictures in three booklets on nutrition and one booklet on pharmaceuticals were replaced with Native American-specific pictures by a printer in Phoenix, Arizona. The IHS has also partnered with the CDC to print extra copies of the new IHS publication Health for Native Life, which is being advertised to the public through the quarterly health supplement of the weekly newspaper Indian Country Today.
An attendee inquired about the activities of IHS's new diabetes programs. Ms. Valdez reported that approximately 60 percent of the projects include activities related to diabetes prevention, such as building walking paths, providing recreational activities for children, and designing educational programs on healthy lifestyles in their communities. There also are secondary and tertiary prevention programs in place.
An attendee asked about the activities of the National Diabetes Prevention Center. Ms. Valdez reported that the activities for the first few years will have a local emphasis and involve a few tribes in New Mexico and the Navajo Nation, which is located in three States. In conjunction with the CDC and the IHS, the University of New Mexico will hold meetings across the country to get direct input from different tribes.
Agency for Health Care Policy and Research: Dr. Dan Stryer
Dr. Stryer reported that AHCPR has two upcoming funding initiatives that are aimed at the President's initiative to eliminate racial disparities in health. One relates to translating research into practice, and the other to identifying underlying factors for disparities and targeting interventions that can eliminate them. The announcements will be posted soon on the AHCPR Website. Dr. Stryer also reported that AHCPR funded a study, whose results were released about a year ago, that examined quality-of-life (QOL) measures for management of diabetes. The researchers found that good diabetes management makes a difference in several QOL measures in a short amount of time.
Roundtable Session: "How Can You Use the NDEP Messages and Materials in Your Program and Work with NDEP to Promote Diabetes Awareness"
Ms. Gallivan and Ms. Rachel Greenberg chaired this open discussion during which the following topics were addressed.
Planned Direction of the NDEP in the Year 2000
Because the distribution of materials of the NDEP's Control Your Diabetes. For Life. campaign has only just begun, the approach in 2000 will be to expand on this effort. The media outreach plan at the national level, using different messages monthly for different minority groups, will filter down to and be adapted by the State and local partners and local communities. Television, radio, and print PSAs will continue to be placed in various media outlets. The PSAs and campaign media and educational materials were developed in consideration of the following:
The type/style of language needed.
What best describes the way people with diabetes talk about their disease and what they think they need.
How to motivate rather than present details in a message.
The need for diabetics to know not only their glucose and hemoglobin A1c values but also the meaning and significance of these values.
The action to take if a glucose or hemoglobin A1c value is high.
The principles that establish controlling diabetes for life.
The audience to whom the message is directed--the patient, family, friends, caregiver.
The needs that a person with diabetes and his or her family have that should be discussed with the caregiver.
Diabetes: A Guide for Communities
NDEP produced this resource guide for community-based partners to help them develop coalitions, programs, and activities about diabetes. There is also a Campaign Guide for Partners, which is a companion piece to the Diabetes Community Partnership Guide. While the partnership guide focuses on developing community-based programming, the campaign guide focuses on using the media for diabetes education.
The NDEP's publication resource list can be ordered from the National Diabetes Information Clearinghouse. The telephone number to call to order materials is 1-800-438-5383. Some items are on the Web and may be downloaded; within a few months, everything will be available on the website. The website address is http://ndep.nih.gov.
Diabetes in Racial/Ethnic Groups
Attendees discussed the similarities and differences among racial/ethnic groups about their attitudes toward diabetes. In each minority group, the level of diabetes awareness is higher than that among whites, and attendees wanted to know the reason for this.
Another point raised was the difference between men and women in their attitudes toward talking about diabetes. Men do not like to talk about it, but women believe it needs to be discussed openly. Because diabetes is a serious disease that must not be ignored, attendees stated that a message is needed to address this problem of reluctance to discuss the disease.
Ms. Joanne Gallivan thanked attendees for participating and adjourned the meeting.
Richard Eastman, M.D., Chair
Diabetes Mellitus Interagency Coordinating Committee, NIDDK
Charles A. Wells, Ph.D., Executive Secretary
Diabetes Mellitus Interagency Coordinating Committee, NIDDK