What's the 7% Solution?

A 7% Solution #1
by Eric Schoch

Standing at the podium at a national diabetes prevention conference in April 2010, Ann Albright of the Centers for Disease Control and Prevention didn't mince words. "This is a game changer. This is a day in which we really are able to change the face of the prevention of Type 2 diabetes," said Albright, director of CDC's Division of Diabetes Translation. "We really are going to be able to deliver on something that is incredibly important.

Albright was announcing a new diabetes prevention initiative, spearheaded by the CDC and two partners, the YMCA and health insurer UnitedHealth Group, just eight years after the publication of a landmark study in the New England Journal of Medicine. That study demonstrated that with the right program and coaching, people at high risk for diabetes could successfully lose enough weight for a long enough time to significantly reduce their risk.

More specifically, the intensive lifestyle intervention, which recommended 150 minutes of exercise per week and a weight loss goal of just 7 percent, reduced the incidence of diabetes by 58 percent. This was — and is — significant at a time when obesity has reached epidemic proportions in the United States, when some 24 million Americans have Type 2 diabetes, and when an estimated 60 million Americans are prediabetic, most of them without even knowing it.

It’s another epidemic in the making

Real-world research

It would seem to be a no-brainer to take the prescriptive techniques of the NEJM study and implement them broadly, except for one problem. In the study, the participants were provided with individual coaching and counseling, but it’s impossible to provide one-on-one lifestyle coaching to millions of prediabetic Americans.

Which brings us to Indiana University School of Medicine researchers David Marrero and Ronald Ackermann, the director and associate director, respectively, of the school’s Diabetes Translation Research Center. The center was created with a mission to “address the gap between developmental and clinical trial research and ‘real-world’ implementation relevant to diabetes.” The diabetes prevention study published in the NEJM in 2002 was conducted at 27 sites, including Indianapolis, where Marrero, the J. O. Ritchey Professor of medicine, was principal investigator. Ackermann, a physician and associate professor of medicine, joined the IUSM in 2003.

During the past decade, Ackermann, Marrero, and their colleagues have made the IU School of Medicine a leader in researching and designing real-world diabetes prevention programs that work. That effort has required addressing some significant problems. First, if you can’t give everyone their own lifestyle coach, how do you translate the program into a group setting, and where? And second, who pays for it?

The answer to the first question turned out to be an unconventional research partner — the YMCA.

Continued tomorrow!

http://research.iu.edu/magazine/index.php?option=com_content&view=article&id=111:a-7-solution&catid=45:fall-2010-volume-xxxiii-number-1&Itemid=78

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