Category Archives: Diabetes
Building on epidemiologic evidence that suggests that healthy behaviors are transmittable across social networks, Microclinic International, a nonprofit international organization based in San Francisco, leverages human relationships to address both non-infectious and infectious diseases such as diabetes and HIV/AIDS. The theory behind the Microclinic International is that if negative behaviors such as smoking, unsafe sex and overeating can be contagious, so can positive, healthy behaviors.
The organization operates through “microclinics” that consist of small groups of people who share access to education, technology and social support as they work together to prevent and manage a deadly disease. Founder Daniel Zoughbie says the organization is “built on social relationships and social capital rather than bricks and mortar.” Microclinic works with local partners through community-based workshops with trained facilitators.
NewPublicHealth spoke with Zoughbie about Microclinic’s potential to reduce incidence of disease, both in the United States and abroad.
NewPublicHealth: What gave you the idea for Microclinic?
Daniel Zoughbie: When I was a college junior at UC Berkeley I wanted to do a junior-senior year project that would involve rigorous research, but also have an immediate impact on a community in need. My grandmother passed away from diabetes many years ago and I realized that a disease like diabetes is relatively simple to prevent and manage, and yet it is a leading cause of death and disability around the world.
So, I came up with the microclinic concept and piloted it in the West Bank with scholarship funds I was awarded at Berkeley. From the initial success of that pilot project I was able to expand to Jordan and recruit colleagues who worked with me to help build the organization. And then we expanded further. Today we’re running three microclinic projects in Kenya, supported by Google and other funders, in Jordan, supported by organizations including the health ministry and Her Majesty Queen Rania Royal Health Awareness Society, and in Appalachia, Kentucky supported by funders that include the U.S. Centers for Disease Control and Prevention and Humana.
NPH: What is the concept behind Microclinic?
Zoughbie: One of the most significant spaces for the prevention and management of major disease epidemics is actually not the formal health care infrastructure of hospitals and clinics alone—it is the spaces of homes and businesses and places where friends and family come together and can positively influence behaviors, such as eating healthy food, walking together, engaging in physical activity and helping each other monitor health conditions. Or, these kinds of spaces can be transformed into places where diseases spread. Families can sit sedentary in front of televisions. They can eat junk food together, and choose not to check on each other in terms of health monitoring and taking medications.
New funding by the National Institutes of Health (NIH) is aimed at improving treatment for bacterial infections, treating alcohol dependence and determining effective drugs for long-term diabetes treatment.
- Antibiotic Resistance: Duke University has been awarded $2 million by the NIH for a clinical research network focused on antibacterial resistance. Funding could rise to close to $70 million by 2019. According to the NIH, bacterial infections resistant to antibiotic drugs were first reported more than 60 years ago and since then have become more common in both health care and community settings. In some cases, no effective antibiotics exist. The funding will be used to conduct clinical trials on new drugs, optimizing use of existing ones; testing diagnostics and conducting research on best practices for infection control.
- Alcohol Dependence: A new study funded by the NIH and published in the Journal of Addiction Medicine finds that the smoking-cessation drug varenicline (brand name Chantix), significantly reduced alcohol consumption and craving among people who are alcohol-dependent. “Current medications for alcohol dependence are effective for some, but not all, patients. New medications are needed to provide effective therapy to a broader spectrum of alcohol dependent individuals,” said says Kenneth R. Warren, PhD, acting director of the National Institute on Alcohol Abuse and Alcoholism, part of NIH. Participants who took varenicline, compared with those taking a placebo, decreased their heavy drinking days per week by nearly 22 percent.
- Diabetes: The NIH is currently recruiting volunteers for a study to compare the long-term benefits and risks of four widely used diabetes drugs in combination with metformin, the most common first-line medication for treating type 2 diabetes. The study is important because if doctors find that metformin is not effective enough to help manage type 2 diabetes, they often add another drug to lower blood glucose levels. However, there have been no long-term studies on which of the add-on drugs are most effective and have fewest side effects. The study will compare drug effects on glucose levels, adverse effects, diabetes complications and quality of life over an average of nearly five years and will enroll about 5,000 patients at 37 study sites.
John Buse, MD, PhD, director of the Diabetes Care Center and chief of the Division of Endocrinology at the University of North Carolina at Chapel Hill School of Medicine, was just recently named the new chair of the National Diabetes Education Program (NDEP), a joint program of the National Institutes of Health and the Centers for Disease Control and Prevention.
The role of NDEP, established in 1997, is to foster public and private partnerships to improve diabetes management and outcomes, to promote early diagnosis, and to prevent or delay the onset of type 2 diabetes in the U.S. Currently, nearly 26 million Americans have diabetes, and 79 million have prediabetes, which puts them at increased risk for developing type 2 diabetes and heart disease. Over the next decade, an estimated forty million more U.S. adults could develop the condition.
NewPublicHealth spoke with Dr. Buse recently about his new position at NDEP.
NewPublicHealth: What innovations might you like to try at NDEP?
Dr. Buse: I think the program has been remarkably successful over almost 15 years. NDEP has developed a lot of materials, and the focus now is on working through partnerships to get the materials out there to a greater extent. Our research unit at UNC has done a lot of work with the pharmaceutical industry and clinical trials in diabetes and cardiovascular disease and I do think there’s an opportunity to partner with industry. They provide materials to primary care doctors and health care systems to use in patient education. They generally develop those materials themselves. I think there’s potentially an opportunity to have them use the NDEP materials with the NDEP being sort of an honest broker in developing educational programs free of undue influence from the pharmaceutical industry. So I think that’s a potential opportunity. The resources of NDEP are pretty modest compared to the scope of the diabetes problem, so leveraging our little tiny budget through partnerships is really the way to have an impact.
And as universal health care coverage is slated to come into existence in 2014, the improved access to care will create lots of opportunities to improve diabetes care and the education is really critical in that process. Health care systems and insurance plans and legislatures are looking more and more carefully at diabetes and obesity as major areas of cost and expenditures.
NPH: Can you tell us the key mandates of NDEP?
A new study in the journal Health Affairs has found that young people with diabetes are more likely to drop out of high school and could expect to earn about $160,000 less than those without diabetes over their lifetimes. That’s on top of medical expenses that can average $6,000 per year for medicine, testing equipment and physician visits. The Health Affairs article used data from the U.S. National Longitudinal Study of Adolescent Health to look at the non-medical costs associated with diabetes.
NewPublicHealth spoke with Michael R. Richards, a co-author of the study and a graduate student in health economics in the Division of Health Policy and Administration at the Yale School of Public Health. Richards says the study is important because often the urgency that is associated with diabetes focuses on long-term health consequences—outcomes that happen later in life.
“Our work suggests that urgency should be brought forward earlier. We need to be looking at long- and short-term consequences—including educational attainment and income levels. Richards says not enough is known yet to help formalize policies on how to deal with short-term issues, but that the next step in the research by the study authors is to uncover the mechanisms that are driving these outcomes. “Once we know the mechanisms,” says Richards, “it will be easier to plan next steps.”
>>Read the Health Affairs article here.
“It’s not easy but it’s worth it,” is the very important message from the National Diabetes Education Program (NDEP), a partnership between the Centers for Disease Control and Prevention and the National Institutes of Health. The Partnership is promoting that message and a very useful library of resources in observance of National Diabetes Awareness Month in November. The critical need to get people to manage or prevent diabetes grows each year. Currently, 26 million Americans have diabetes and 79 million are at risk of developing the disease.
The NDEP resource library has numerous entry points including age, diabetes status and ethnicity, which link site users to targeted materials that address their specific needs and concerns. It also has entry points for community health workers, community organizations and teachers with resources such as a variety of toolkits for diabetes outreach.
Recommendations on the site help make managing or preventing diabetes more manageable for many people:
- Think about what is important to you and your health.
- What changes are you willing and able to make?
- Decide what steps will help you reach your health goals.
- Choose one goal to work on first. Start this week. Pick one change you can start to make immediately.
- Don't give up. It's common to run into some problems along the way. If things don’t go as planned, think about other ways to reach your goal.
Read more on diabetes prevention and other diabetes news here.