![](https://webarchive.library.unt.edu/eot2008/20090117101840im_/http://www.cdc.gov/navimages/spacer.gif)
![](https://webarchive.library.unt.edu/eot2008/20090117101840im_/http://www.cdc.gov/navimages/spacer.gif)
![](https://webarchive.library.unt.edu/eot2008/20090117101840im_/http://www.cdc.gov/navimages/spacer.gif)
|
![](https://webarchive.library.unt.edu/eot2008/20090117101840im_/http://www.cdc.gov/navimages/spacer.gif) |
Publications and Products
Interim Report:
Proposed Recommendations for Action
A National Public Health Initiative on Diabetes and Women's Health
Return to the Contents
Disease Tracking and Research Recommendations
This section highlights priorities for disease tracking and research
to further knowledge about the impact of diabetes on womens health.
Recommendations are divided into five categories: disease tracking, epidemiologic
research, socioenvironmental and behavioral research, translational research,
and biomedical research.
Disease Tracking covers the ongoing and systematic collection,
analysis, interpretation, and dissemination of data to understand the
nature and extent of diabetes and its complications among women, including
changes over time in incidence, prevalence, and risk factors.
Epidemiologic research questions address population-based studies
to better identify and understand the distribution of diabetes and its
risk factors among women.
Socioenvironmental and behavioral research questions explore the
identification and analysis of social, behavioral, economic, and political
factors influencing diabetes and its complications among women.
Translational research questions address studies that aim to convert
findings from other types of research into practical programs, policies,
techniques, and materials for real-world settings.
Biomedical research questions involve basic science and clinical
research aimed at characterizing the mechanisms and risk factors that
influence diabetes and its complications among women. This document emphasizes
prevention and public health, but advances in relevant clinical and basic
science research could enhance the effectiveness of public health programs
and policies.
Recommendations for disease tracking and research questions that pertain
to all women are presented first, followed by additional research topics
that are pertinent to each life stage.
All Women
Disease Tracking
To enhance disease tracking of diabetes among women and its impact on
their health, the following actions are recommended:
- Define and monitor the geographic distribution of diabetes among
females.
- Expand population-based disease tracking to monitor and understand
intragroup variations in disease distribution and the factors (such
as cultural, racial, ethnic, geographic, demographic, socioeconomic,
and genetic) that influence risks for diabetes and complications.
- Establish routine disease tracking of the quality of care for women
of childbearing age (for example, the Pregnancy Risk Assessment Monitoring
System [PRAMS] for women who have had a recent live birth) and women
in later years.
- Routinely collect and analyze disease tracking data by life stage.
- Design disease tracking systems to track and assess where and from
whom women are receiving health care.
Epidemiologic Research Questions
- What valid indicators can be used to measure intragroup variations
(such as cultural, demographic, socioeconomic, and genetic factors)
in disease distribution that influence the risk for diabetes and its
complications?
- How do changes in diet, physical activity, psychosocial stress, and
work conditions affect the onset of diabetes, particularly for immigrant
and disadvantaged populations?
Socioenvironmental and Behavioral Research Questions
- What are some of the psychosocial factors and measures that facilitate
(or hinder) successful completion of interventions designed to promote
diabetes self-management?
- What are womens perceptions of health care providers recommendations?
- To what extent are the recommendations of health care being followed
after patients leave the office?
- Do health care professionals clearly explain recommendations and
instructions for care so that patients can comprehend them?
- What barriers do women face in trying to follow the recommendations?
- What are the care-seeking behaviors of the uninsured and the working
poor?
- How does physical activity change over the life span, and how does
this influence the risk for diabetes?
- What is the effect of depression on the lives of women living with
diabetes, including their ability to self-manage, obtain adequate health
care, and control their risk for diabetes complications?
- How can interventions with immigrant populations encourage physical
activity and positive dietary patterns after they move to urban or other
new settings?
- What are the best practices for diabetes self-management, use of computerized
learning programs, and support groups?
- What is the effect of family structure, income, education, and community
factors on diabetes risk, prevention, and care?
- What is the role of social isolation in accelerating risk factors
that lead to diabetes and its complications, and at which life stages
is it most critical?
- What influence do culturally relevant or health-relevant aspects of
religious practice have on health?
Translational Research Questions
In Health Communications and Program Design
- What are the knowledge level, attitudes, and perceptions of diabetes
risk among health care providers, patients, and the general population,
and how do these vary by age, race, ethnicity, and culture?
- What are the communitys perceptions of appropriate risk reduction
strategies (including programs, resources, and priorities), and to what
extent does community-wide buy-in exist for application
of these strategies?
- How do the history and traditional beliefs of a racial, ethnic, or
cultural groups affect health messages and intervention design and delivery
about diabetes and its risk factors?
- How can healthy uninsured and underinsured persons be reached, and
what messages do they need to hear about diabetes prevention?
- How can women who do not believe in allopathic medicine be reached?
- How can the media be used effectively to reach and mobilize various
communities and populations?
- What makes a media message persuasive enough to change behavior?
- Do these elements differ by racial, ethnic, cultural, educational,
and religious groups?
- What diabetes education literature is available for women of different
ages or life stages, in different languages, and for low-literacy populations?
- What is the quality of that literature?
- Does it cover all aspects of diabetes?
- What adaptations to existing diabetes prevention program materials
and methods are needed to be effective for pregnant, postpartum,
and nonpregnant women?
- How do women with diabetes rank health issues with regard to primary,
secondary, and tertiary care?
- Do they have different concerns at different life stages or levels
of care?
- What would encourage them to respond differently to these levels?
- How, where, and from whom do women prefer to receive health information
for primary, secondary, and tertiary levels of prevention?
- How can other organizations and programs be convinced to incorporate
diabetes messages?
- What are effective ways to encourage women to participate in preventive
behaviors?
- What strategies will effectively maintain or increase physical activity
and healthy eating at critical times in a womans life, such as
transition to adolescence, pregnancy, or postpartum?
- What are the characteristics of diabetes-related prevention and intervention
services that contribute to effective recruitment, retention, and achievement
of stated aims for women at different life stages?
- What is the most effective way to identify leadership and empower
specific groups of women to promote disease prevention and management?
- How can traditional public health organizations and programs best
partner with those outside of public health to benefit women with diabetes?
In Health Service Delivery
- How do women define an effective source of diabetes services, and
what do women with diabetes look for and want in health services?
- What models of effective diabetes-related preventive care services
exist or can be tested?
- What diabetes education classes or medical nutrition therapy classes
are available and paid for by health insurance plans?
- What tests and information are various types of health care providers
including in their standard examinations and counseling sessions (particularly
in settings that serve large numbers of minority patients? Are mutually
agreed upon goals established?
- Do health care providers follow accepted guidelines for prevention
and management of diabetes?
- Are there differences in care for different population groups?
- Are there differences between types of health care providers?
- What strategies can best be used to deliver prevention messages and
interventions to patients who present in emergency rooms, and are there
opportunities to reach women through other health care professions or
venues (such as pharmacies)?
- What are the effects on diabetes care of moving from one health care
professional to another as treatment and age demands (for example, from
pediatricians to gynecologists or from general practitioners to ophthalmologists),
and what are effective strategies for maintaining continuity of care?
- What is the relationship between diagnosis, treatment, and postpartum
follow-up of gestational diabetes and the risk for subsequent gestational
diabetes, polycystic ovary syndrome, and type 2 diabetes?
- What strategies best improve communication between health care professionals
and women of different cultures, races, ethnicities, ages, and so on?
- Do uninsured and underinsured women, including the working poor, access
diabetes care?
- If so, how?
- What is the best way to provide services to these women?
- How can employers and health insurers be motivated to include essential
elements in their diabetes benefit packages?
- What standardized diagnostic testing protocol (for example, time of
day and meals prior to testing) will allow valid comparisons within
and between various demographic groups?
- How can the team approach to diabetes care be implemented?
In Health Economics
- What is the lifetime cost of health care (including clinical system
cost, patient cost, support systems cost, supplies, and equipment) for
a woman diagnosed with diabetes at various life stages?
- What are the direct and indirect costs of undiagnosed and untreated
diabetes during pregnancy for the mother and her baby?
- What are the costs associated with long-term diabetes prevention programs,
such as regular physical activity and healthful eating?
- What are the societal costs of diabetes among women in terms of lost
productivity, lost time at work, disability, social assistance, and
premature death?
- What are the most cost-effective interventions, both traditional and
nontraditional?
- How do changes in cost or health insurance coverage affect outcomes?
Biomedical Research Questions
- What is the natural history of the development of diabetes in women?
- What are the most critical periods (fetal, perinatal, childhood, adolescence)
for an intervention to have maximum affect on long-term outcomes?
- How can we advocate that biomedical research involve more women? How
can we extrapolate biomedical research findings from men to women?
The Adolescent Years (ages 10-17 years)
Many of the research questions listed in the previous section pertain
to adolescents. This section highlights additional questions unique to
the life stage that encompasses females aged 10-17 years.
Epidemiologic Research Questions
- Does the level of physical activity change during the adolescent years?
- If so, how and why?
- How does this affect the risk for diabetes?
- How nutritious are school lunches, and what types of snacks and drinks
are offered in school vending machines?
- What is the content and quality of physical education classes and
curricula?
- What percentage of adolescents participate in organized sports or
other physical activity, and with what health benefits?
Socioenvironmental and Behavioral Research Questions
- What are the effects of peer pressure and other psychosocial factors
on eating habits and participation in physical activity during adolescence,
and how do they vary by culture, race, ethnicity, or income?
- What is the role of school systems in encouraging environments that
enhance diabetes prevention opportunities (for example, increasing diabetes
awareness and encouraging physical activity and healthy eating)? Are
dietary standards and physical education standards followed?
- What impact have new school, health care, and other social policies
over the past decade had on the incidence of diabetes among adolescent
females?
- Are female adolescents who work outside the home at more or less risk
of developing obesity or diabetes? If so, why?
Translational Research Questions
In Health Communications and Program Design
- Who will adolescent females talk to about personal and sensitive health
issues?
- What is the impact of advertising on adolescent females food
choices and eating habits and on their participation in physical activity?
- What are adolescent females perceptions and knowledge about
healthy eating and physical activity, and what are the consequences
of these perceptions and knowledge?
- Where do adolescent females get diabetes information that they consider
important and credible, and what are effective ways to communicate this
information to them?
- How can food practices be altered, such as fast food choices, school
vending machine selections, and foods served at sporting events and
movies?
In Health Service Delivery
- What is the pediatricians role in preventing, diagnosing, referring,
treating, and following adolescent females with gestational diabetes
and polycystic ovary syndrome?
- How well do health care providers distinguish type 1 diabetes and
type 2 diabetes developed during adolescence?
- What is the role of school nurses in preventing, identifying, treating,
and referring students with diabetes?
- What is the extent of health care professionals knowledge of
the risk factors, diagnosis, and treatment of type 2 diabetes in children?
In Health Economics
- What are the costs of type 2 diabetes prevention in youth?
Biomedical Research Questions
- What is the most effective use of insulin versus oral agents among
adolescents?
The Reproductive Years (ages 18-44 years)
Specific research questions for the life stage covering ages 18-44 years
are itemized below.
Socioenvironmental and Behavioral Research Questions
- What are the family and community support systems for reproductive-aged
women with diabetes, and how can their development be encouraged?
- What are the determinants of womens behavioral of patterns and
attitudes regarding physical activity during the reproductive years?
How can it be made more socially acceptable to include physical activity
and healthy eating as normal parts of everyday life during the reproductive
years?
- What is the impact of depression and eating disorders on the lives
of reproductive-aged women with diabetes, including their ability to
self-manage, obtain adequate health care, and control their risk for
diabetes complications?
Translational Research Questions
In Health Communications and Program Design
- What are the beliefs of health care providers and patients about gestational
diabetes, its seriousness, and its consequences, and what is the impact
of these beliefs on content and quality of care?
- How can the future risk for developing diabetes be communicated to
women diagnosed with gestational diabetes?
In Health Service Delivery
- What is the pattern of health care use for reproductive-aged women
with diabetes, and how does this pattern vary with socioeconomic status?
- What are the best methods for diagnosing and treating women who may
not use reproductive health services?
- Are current standards of prenatal and postpartum diagnosis and follow-up
care being followed?
- At what proportions and with what quality?
- Which groups of women are most likely to receive inadequate follow-up
care?
- What is the extent of postpartum follow-up of women with gestational
diabetes and women at high risk of developing diabetes?
- How can existing opportunities or new opportunities be used to identify
high-risk women for early intervention and prevention activities (for
example, clinics for family planning, prenatal care, postpartum care,
or WIC)?
- What is the pediatricians role in following up with women who
have been diagnosed with gestational diabetes?
- What models exist for effective delivery of health care for reproductive-aged
women in terms of diabetes prevention and management?
Biomedical Research Questions
- Among women of reproductive age, to what extent is depression an indicator
or potential risk factor for developing diabetes, eating disorders,
or other conditions?
- What effects do changes in weight, diet, and physical activity during
and after pregnancy have on the risk of developing gestational diabetes
and type 2 diabetes?
- Can early behavioral intervention reduce the risk of gestational diabetes?
- Can effective control of gestational diabetes reduce the womans
risk of subsequent type 2 diabetes?
- What is the interaction between contraception choice and the risk
of developing diabetes?
The Middle Years (ages 45-64 years)
Additional recommendations for research regarding women in the middle
years (ages 45-64 years) are listed below.
Socioenvironmental and Behavioral Research Questions
- What types of health care professionals and health care services do
women in middle age seek?
- What is the role of spirituality and natural medicine in maintaining
and improving health among middle-aged women with diabetes?
- To what extent does the caretaker role for elderly parents, children,
and families interfere with a womans ability to provide self-care
or seek health care services for herself?
Translational Research Questions
In Health Communications and Program Design
- How, where, and from whom do women in middle age prefer to receive
health information for primary, secondary, and tertiary levels of care?
- What diabetes education literature and interventions are available
for women in their middle years, and how effective are they for different
literacy levels, languages, cultures, religions, races, and ethnicities?
- What interventions for diabetes in the middle years will best affect
long-term outcomes and improved quality of life?
- How should the delivery of prevention services to middle-aged women
with diabetes be designed?
In Health Economics
- What affects do diabetes self-management policies have on small and
large businesses?
Biomedical Research Questions
- How can middle-aged women with diabetes and comorbidities be supported
and their conditions managed?
The Older Years (ages 65 and older)
Research questions pertinent to women aged 65 years and older are as
follows:
Socioenvironmental and Behavioral Research Questions
- Are there differences in methods used to alter behaviors related to
diet and physical activity later in life than at other life stages?
- How are aging networks and other community coalitions being used to
reach the elderly with diabetes education, and how effective are they?
- How can peer volunteers and other strategies be best used to support
families?
- Are there grassroots organizations, such as churches and beauty shops,
which provide ongoing support groups for older women with diabetes?
- How can additional grassroots organizations be encouraged to get
involved?
- What are other sources of support in the community for older women
with diabetes?
- To what extent does caring for a frail, elderly spouse interfere with
a womans ability to provide self-care or seek health care services
for herself?
Translational Research Questions
In Health Communications and Program Design
- What are the most effective methods for educating the elderly about
medical nutrition therapy, detection, comorbidities, and the importance
of regular physical activity?
- Are easy-to-read, understandable publications available to help elderly
women comprehend how a new diet and physical activity regimen will help
control their diabetes?
In Health Service Delivery
- How can patients time with a health care worker be maximized
to better support the patient in incorporating diabetes management into
their lifestyle?
- What are health care providers perceptions of caring for elderly
women with diabetes, and how do these perceptions influence the quality
of care and services provided?
- What are the use, compliance, participation, and outcome rates of
available health care programs and services for older women?
- How can health care provisions such as prescription drug coverage
be ensured for the Medicare population that is underinsured?
- How can the quality of care for the elderly be improved through affordable
health insurance, better access to health care, or education for health
care providers?
Biomedical Research Questions
- What is the connection between depression, physical activity, healthy
eating, interpersonal relationships, and diabetes in the older years?
- To what extent does multiple prescription drug use in the elderly
years interfere with diabetes self-management?
- How is physical activity limited by arthritis, the risk of falls,
general frailty, and osteoporosis?
Top of page
Historical
Page last modified: December 20, 2005
Content Source: National Center for Chronic Disease Prevention and Health Promotion
Division of Diabetes Translation
|