MD Conference Express - (Page 16)
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F E A T U R E
Treat the Individual, Tend to the Population
Written by Neil Canavan and Beth Johnson
The concept that the clinical successes that are seen in individual patients can and must be replicated and scaled up to a population level if we are ever to have a world that is free of diabetes and its complications was the subject of the State-of-the-Art Lecture at the 70th Scientific Sessions of the American Diabetes Association. Ann Albright, PhD, RD, Director, Division of Diabetes Translation, Centers for Disease Control, Atlanta, GA, represented this concept using an ecological model, visually represented by an image of concentric circles—the individual at the center, surrounded by extended family and friends, encircled by the culture, and encapsulated by the community (Figure 1). Dr. Albright encouraged policymakers and public health professionals, as well as health care providers, to be mindful of the importance of achieving population goals without losing sight of the individual. “The health of individuals is inseparable from the health of communities and societies,” she said. Figure 1. Ecological Model. As a result of improved medications and devices, advances in self-management, and community-based training, there have been Community and policy improvements in diabetes care on an individual level. Data from 1995-2005 show System, group, culture that advances in care have brought about decreasing rates in some comorbidities that are associated with diabetes. Vision loss Family, friends, small group has decreased 25%; foot ulcers and amputations are down 36%; kidney failure has declined by 23%; and cardiovascular Individual disease hospitalizations are down 16% [www.cdc.gov/diabetes]. Despite this progress, population-based measurements show that care for many subpopulations of Americans with diabetes still falls short. It is The health of individuals is inseparable from the health of communities (Healthy People 2010) estimated that 2 in 5 people with diabetes Reproduced with permission from A. Albright, PhD. still have poor lipid control, 1 in 3 have poorly controlled blood pressure, and 1 in 5 have not achieved glycemic control [Saaddine et al. Ann Intern Med 2006].
Ecological Model
Highlights from the
The number of people with diabetes continues to grow. Data from 1997-2003 indicate that the incidence (new cases) of diabetes has increased from 4.9 to 6.9 per 1000 population (p<0.01), and the prevalence of obesity between 1997-1998 and 2002-2003 has risen from 14.2 to 18.3 per 1000 population (p=0.02) [Geiss LS et al. Am J Prev Med 2006]. Increasing life expectancy, earlier diagnosis, and fewer people going undiagnosed account for some of the increased prevalence of diabetes, but the increase in new cases of diabetes is the major contributor. Unfortunately, the gains that are being made in diabetes control are being overwhelmed by the increased incidence. Continued advances for those with the disease, as well as for those who have yet to develop it, are needed. Wise choices should be made about programs and public policies that will have the greatest impact and can
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August 2010
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Table of Contents for the Digital Edition of MD Conference Express
MD Conference Express
Contents
Real-Time Continuous Glucose Monitoring and Diabetes Treatment
The Globalization of Diabetes
Treat the Individual, Tend to the Population
Microvascular Outcomes from the ACCORD Trial
Diabetic Retinopathy in the ACCORD Trial
Results from the STAR 3 Study
Findings from HELP PD
Insights from the BARI 2D Trial
Effect of Atorvastatin on Beta Cell Function
Caffeine Supplementation Reduces Exercise Induced Hypoglycemia
Cardiometabolic Risk
Point of Care Devides
Newer Insulins
Diabetes, Glycemia and Cardiovascular Disease: Is it Time to Rethink the Regulatory Approach?
Diabetes and Cancer: ADA Consensus Statement
The Diabetic Foot Wound
HEALTHY Study - Middle School-Based Intervention to Reduce Diabetes Risk
MD Conference Express
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