Download Health Behavior Research Priorities: Diabetes

Current Funding Priorities in Health
Behavior and Health Behavior Change
at NIDDK
June 20, 2014
Christine Hunter, Ph.D., ABPP
Director of Behavioral Research
National Institute of Diabetes & Digestive & Kidney Diseases
[email protected]
NIDDK’s MISSION
To support and conduct research to combat diabetes and
other endocrine and metabolic diseases, liver and other
digestive diseases, nutritional disorders, obesity, and
kidney, urologic and hematologic diseases.
Chronic
Common
Consequential
Costly
Scope, Consequences, and Cost
Obesity
• Approx. 2/3 of
U.S. adults
overweight or
obese
• Approx. 1/3 of
U.S. adults obese
• High rates in the
young
• Annual cost:
$147B
Type 2
Diabetes
• Approx. 25.8
million U.S. cases
(8.3% of
population)
• Projected to ~50
million by 2050
• Increasing in the
young
• Annual cost:
$245B
↑ 41% since 2007
Chronic
Kidney
Disease
• Approx. 23 million
U.S. cases of CKD
• Major causes:
diabetes,
hypertension
• ESRD annual cost:
$27B
Health Behavior Research Priorities
Strategic Plans
http://www.niddk.nih.gov/about-niddk/strategic-plansreports/Pages/advances-emerging-opportunities-in-diabetesresearch.aspx
http://www.obesityresearch.nih.gov/about/strategic-plan.aspx
Health Behavior Research Priorities:
Diabetes
• Lifestyle change to prevent diabetes (e.g., DPP, LookAHEAD )
• Dissemination and implementation research
• Evaluating efficient and sustainable models of delivery
• Engaging high risk populations
• Maintaining changes over time
• Tension between tailored and generalizable
• Healthcare team/system research
• Screening for diabetes and effectively communicating risk
• Screening and follow-up related to gestational diabetes
• More rapid medication intensification
Health Behavior Research Priorities:
Diabetes
• Adherence to a complicated and unremitting regimen with
serious long and short-term consequences for non adherence
• Frequent daily blood glucose monitoring, adjusting insulin
dosages, additional medications, attention to all food intake
and physical activity, managing co-morbidities…
• Effectively using existing diabetes technologies: blood
glucose monitors, CGM, pump, pen, etc
• Support/skill needs vary across the lifespan and type of diabetes
• Young children, adolescents, young adults, and the elderly
• Involving the patient, their family, and support networks?
Health Behavior Research Priorities:
Obesity
Eat Less and Exercise More
So simple in principle…
yet so complicated in practice
8
A Few of the Challenges
 A healthy lifestyle requires vigilance over time
 Initiation behavior change is challenging but understanding
how to sustain change is a key challenge
 Ubiquitous presence of highly palatable (rewarding) foods
 Increased activity/reduced sedentary lifestyle is not the default
and there are many barriers to exercise
 Need to better identify the drivers of decision making and action in
food and activity choices?
Understanding Individual Variability
 Within similar environments there
is considerable individual
variability in weight and weight
gain trajectory
 Improved understanding of
behavioral phenotypes is needed
to advance obesity prevention
and treatment
Four-Year Weight Loss Trajectories of 887
ILI Participants Who Had Lost ≥ 10%
Initial Weight at Year 1
+4
+2
0
2
4
6
8
10
12
14
16
18
Percentage Weight Loss
 A permissive food environment
and sedentary lifestyle contribute
to obesity
N=88
(9.9%)
Gained
N=174
(19.6%
)
N=99
(11.2%
)
N=15
2
(17.1
%)
0-5%
56.9%
710%
≥ 10%
N=374
(42.2
%)
1
2
Year
3
4
Basic Behavioral Science/Behavioral
Phenotyping
 Greater understanding about why people behave as they do
in regard to intake, physical activity, and sedentary behavior
 Mechanisms, processes, and patterns of behavior and
social functioning that can partially explain individual
differences in weight
 Need to understand:
 Strength of influence
 Variation across populations
 How these factors interact with each other, biological
influences/genes, and the environment
NIDDK Research Behavioral Priorities
• Continued emphasis:
– High risk populations/ reducing health disparities
– More potent and durable interventions
– Potential scalability and sustainability in to “real world”
context and practice
• New emphasis—the “ends” of the translational continuum:
– Basic behavioral science and bench to bedside translation
– Evaluation of natural experiments
– Pragmatic research
Evaluation of Natural Experiments in Obesity
• PAR 12-257: Time Sensitive Obesity Policy and Program
Evaluation (R01)
 NIDDK, NCI, NICHD, NIA, and OBSSR
 Accelerated review/award process (4 months from receipt)
 PA 13-110: Obesity Policy Evaluation Research (R01)
 NIDDK, NCI, NICHD, NHLBI, NIA, and OBSSR
 PA 13-100: School Nutrition and Physical Activity Policies,
Obesogenic Behaviors and Weight Outcomes (R01)
 NICHD, NCI, NHLBI, and OBSSR
 PA 13-098: (R21), NICHD, NCI, NHLBI, and OBSSR
 PA 13-099: (R03), NICHD, NCI, and OBSSR
Evaluation of Natural Experiments in
Diabetes
•
•
•
•
(R18) PAR-13-365
Escalating rates of diabetes and healthcare costs
A time of dynamic change for healthcare in the U.S.
Often, limited evidence about how well they work
• Support rigorous evaluation of “natural experiments” to
prevent or treat diabetes in healthcare settings
– Identify what works for whom in clinical practice with diverse
populations, and/or patients with multiple co-morbidities
– Provide data to more rapidly inform clinicians, healthcare
systems, employer/purchasers, and policy makers
Pragmatic Research in Healthcare Settings
to Improve Diabetes Prevention and Care
• (R18) PAR-13-366 and (R34) PAR-13-367
• Research that maximizes the applicability and relevance of the
trial’s results to routine care/community conditions
– Test novel, practical, and cost efficient healthcare based
strategies to improve health outcomes
• Key Considerations for Funding:
– Integrated into existing healthcare settings
– Leveraging existing resources within these practices
Other Health Behavior Relevant NIDDK
Issued or Partnered Funding Opportunities
Translational Research to Improve Diabetes and Obesity
Outcomes (R01)
PA-13-352
Addressing Health Disparities in NIDDK Diseases (R01)
PA-13-183
Home and Family Based Approaches for the Prevention or
Management of Overweight or Obesity in Early Childhood (R01)
PA-13-153
Home and Family Based Approaches for the Prevention or
Management of Overweight or Obesity in Early Childhood (R21)
PA-13-154
Diabetes Impact Award-Closed Loop Technologies: Clinical,
Physiological and Behavioral Approaches to Improve Type 1
Diabetes Outcomes (DP3)
RFA-DK-14-014
Other Health Behavior Relevant NIDDK
Issued or Partnered Funding Opportunities
Chronic Illness Self-Management in Children and Adolescents
(R01)
PA-14-029
Health Promotion Among Racial and Ethnic Minority Males (R01) PA-13-328
Behavioral and Social Science Research on Understanding and
Reducing Health Disparities (R01)
PA-13-292
Dissemination and Implementation Research in Health (R01)
PAR-13-055
Behavioral Interventions to Address Multiple Chronic Health
Conditions in Primary Care (R01)
PA-14-114
Understanding and Promoting Health Literacy (R01)
PAR-13-130
Some Final Thoughts…
 Don’t feel locked into finding the perfect FOA
 If you don’t find a perfect match, use the “parent” FOAs
 Innovative investigator initiated research is highly valued and
funded
 Innovation is important but significance and approach often drive
the score
 Be very clear about why your research fills an important gap
and why the answers will matter?
 Contact a program officer early in the process!
Questions?
Percentage of U.S. Adults who are
Obese and Diabetic
Obesity
1994
<14%
2000
14-17.9%
2010
18-21.9%
22-25.9%
≥ 26%
6.0-7.4%
7.5-8.9%
≥ 9.0%
Diabetes (diagnosed)
<4.5%
4.5-5.9%