Diabetes Research and Training Centers’ Prevention and Control Divisions
The Diabetes Research and Training Center (DRTC) program was established in 1977 by the Diabetes Research and Education Act (Public Law 91-354) in response to a recommendation by the National Commission on Diabetes. Currently, six DRTCs are supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The DRTCs, which carry out basic and clinical research, are located at major academic institutions.
Each DRTC includes a Prevention and Control Division that focuses on issues related to diabetes translation, including diabetes education, professional training, and community outreach. (The Prevention and Control Divisions were formerly called Demonstration and Education Divisions.) The researchers in the Prevention and Control Divisions develop and demonstrate innovative approaches to providing quality diabetes care. Several of the centers carry out their programs onsite in model demonstration units, while other centers conduct their programs in community settings. The Prevention and Control Divisions have developed links with major diabetes professional and voluntary organizations as well as with groups in the communities served by the centers.
The Prevention and Control Divisions offer continuing education seminars, workshops in state-of-the-art diabetes management for professionals, an array of tested evaluation and assessment instruments, and professional expertise in developing and implementing diabetes programs in a variety of settings.
Each center offers a range of educational materials, including videotapes, curricula, and program guides for health professionals. The following briefly describes the current activities at each DRTC Prevention and Control Division.
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The Albert Einstein College of Medicine DRTC Prevention and Control Component
Dr. Elizabeth A. Walker directs the Prevention and Control (P & C) component of the Albert Einstein College of Medicine in the Bronx. The multidisciplinary clinical and behavioral research team develops and evaluates interventions for preventive diabetes care and self-management, focusing on the health disparities of underserved and high-risk populations.
The P & C cores provide services to investigators with peer-reviewed NIH support or other funding to address diabetes-related issues in translation of research, in facilitation of clinical research, and in evaluation of health promotion interventions.
Einstein P & C research has lead to the development and evaluation of
Interventions to promote ophthalmic screening in diabetes—This funded research has demonstrated that a multicomponent health education intervention, including print, video, and tailored telephone counseling, can be highly effective in improving the ophthalmic screening rates among African Americans with diabetes. A more broad-based telephone intervention for both Spanish- and English-speaking populations in the Bronx is under evaluation for cost-effectiveness. Interactive multimodal weight-control intervention—This research addresses techniques to optimize staff time in providing a weight control intervention. The American Diabetes Association has published the patient workbook and the staff curriculum from this research under the titles The Complete Weight Loss Workbook: Proven Techniques for Controlling Weight-Related Health Problems and The Leaders Guide for the Complete Weight Loss Workbook. The interactive computer system that helps patients individually tailor the weight loss approach has been converted to HTML code to make it usable via the Internet. Related collaborative investigations have lead to the development of materials to facilitate addressing Weight, Activity, Variety, and Excess (WAVE) as nutritional issues in primary care. Risk perceptions for developing diabetes—This survey research explores perception of risk for developing diabetes relative to environmental risks, and other disease risks in lay, expert and at risk for diabetes populations. Under evaluation is a survey for perception of risk for diabetes complications, a similar assessment for individuals with diagnosed diabetes. Medication adherence has been studied in the Diabetes Prevention Program in individuals at high risk for developing type 2 diabetes. The intervention includes a structured interview for assessment of barriers to adherence, strategies to improve adherence to medication, and the use of a toolbox approach and motivational interviewing to tailor the plan for the individual.
Health professional education programs include
A diabetes management preceptorship offered in conjunction with graduate or
postgraduate training programs for physicians, advanced-practice nurses, dietitians, and clinical health psychology trainees. A weekly basic science and clinical research conference, including topics in the multidisciplinary management of diabetes, new findings on diabetes clinical research, and basic research.
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University of Chicago’s DRTC Prevention and Control Division
Dr. Donald Steiner directs the Prevention and Control Division of the University of Chicago DRTC. Many of the programs focus on improving the quality of care and outcomes of vulnerable patients with diabetes, including indigent and minority persons. University of Chicago faculty from the medical and social sciences collaborate to design and implement diabetes programs that can work in diverse settings. Current projects include
Improving Diabetes Care in Midwest Community Health Centers—The Chicago DRTC is collaborating with the MidWest Clinicians’ Network, a consortium of 70 community health centers in 10 Midwestern states that serve the indigent. We are improving diabetes care in the health centers with rapid quality improvement methods, chronic care models, training to enhance communication between providers and patients, and programs to empower patients to take a more active role in their care. Chicago Department of Public Health Neighborhood Clinics—Within Chicago neighborhood clinics that care for the poor, we are disseminating American Diabetes Association practice guidelines, introducing patient flow sheets, providing continuing medical education to providers, and performing audits of charts for key processes of diabetes care and feeding results back to the clinics. We are also implementing programs to improve providers’ skills at communicating with patients and facilitating behavioral change. Pathways Lifestyle Modification Program for African American Women—Pathways is a successful weight loss program tested in a clinical setting as part of a church-based lay educator program in inner city African American churches. The study demonstrated that a culturally relevant lifestyle program can provide significant weight loss in African American women who typically do not benefit from such efforts. It also provided evidence that lay women can be trained to conduct successful lifestyle modification programs in their own neighborhoods. We are currently testing whether a similar program promoting lifestyle changes in diet and physical activity are sufficient to cause weight loss in subjects with early diabetes.
Other programs developed by the Chicago DRTC include
- From Basics Forward, a comprehensive continuing education program for diabetes educators conducted nationally by the American Association of Diabetes Educators.
- In Control, a clinical patient education program for 9- to 12-year-old children with diabetes and their parents.
- Choices, a problem-solving curriculum to meet the special needs of adolescents with diabetes management problems.
- Get Going, an exercise program for inner-city minority women with diabetes.
- Por Su Salud (For Your Health), a community-based lifestyle intervention that focuses on assisting inner city Hispanic women overcome some of the risk factors for diabetes through healthy eating and physical activity.
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Indiana University’s DRTC Prevention and Control Division
Dr. David G. Marrero directs the Prevention and Control Division of the Indiana University DRTC in Indianapolis. This DRTC division develops model clinical and educational programs relating to low income and minority programs. Many of the programs incorporate computer and telecommunications technology to assist in patient care and professional education.
The Indiana University DRTC has conducted several surveys of primary-care physicians within the State to assess their standards of diabetes care. The results have guided the development of several postgraduate education courses on implementing more intensive diabetes management, detecting and treating secondary complications associated with type 1 and type 2 diabetes, and applying nutrition and exercise in type 2 diabetes.
Materials produced in support of these activities include
- survey and assessment instruments for both patients and health care professionals
- content-specific study guides and video programs demonstrating care
- treatment algorithms
- physician chart "help aids" to facilitate monitoring diabetes care and education programs that use multimedia
The center is developing a program designed to improve the standard of diabetes care in rural, low-income communities.
Go to http://medicine.iu.edu/body.cfm?id=4472&oTopID=2852 for additional information about the Indiana University DRTC.
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University of Michigan’s DRTC Prevention and Control Division
Dr. William Herman directs the Prevention and Control Division of the DRTC at the University of Michigan in Ann Arbor. This division has developed model clinical and educational programs, as well as educational programs and materials for health-care professionals and people with diabetes. Many of the center’s programs for diabetes education and empowerment focus on communities and community organizations.
Along with clinical and educational programs, the University of Michigan DRTC also facilitates disease, cost-of-disease, and quality-of-life modeling to assess the relative effectiveness, cost-effectiveness, and cost utility of alternative strategies for the prevention, detection, and management of type 2 diabetes. In addition, this DRTC supports and coordinates studies that evaluate interventions directed at improving health outcomes of people with diabetes and studies that evaluate barriers that prevent adoption and dissemination of state-of-the-art diabetes care. Specific projects have been developed to evaluate culture-specific diabetes education programs, diabetes care for the underinsured, and people with diabetes in managed care systems.
The University of Michigan DRTC Prevention and Control Division also develops instructional materials and standardized instruments to measure knowledge (Diabetes Knowledge Test), patient self-care skills and practices (Diabetes Care Profile), attitudes of patients and health professionals (Diabetes Attitude Scale), and patient empowerment (Diabetes Empowerment Scale). The center offers an undergraduate course for students at the University of Michigan, other training opportunities for health professionals, and patient education materials. These materials and instruments are available from the center at www.med.umich.edu/mdrtc on the Internet.
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Vanderbilt University’s DRTC Prevention and Control Division
The Prevention and Control Division at Vanderbilt University in Nashville, TN, works closely with Meharry Medical College, Fisk University, Tennessee State University, the county hospital, the local and state health departments, the NAACP, local churches, and concerned citizens to reduce and in time eliminate local racial disparities in cardiovascular disease and diabetes. The work is funded through a CDC REACH 2010 project grant plus other federal and foundation grants. Collaborations designed to reduce disparities involve assessments of community eating behaviors, lifestyles, attitudes toward disease and the health care system, and standards of care. A variety of questionnaires, videos, training materials, and slide presentations related to these efforts are available.
The Vanderbilt University DRTC has a long history of research on improving the teaching skills of health professionals involved in diabetes education and management. The center’s widely attended Effective Patient Teaching (EPT) course emphasizes teaching, promoting adherence, and imparting problem-solving skills. By special arrangement with the Vanderbilt University DRTC, professionals can be trained to present the EPT program to colleagues in their own institutions.
The center also offers the program Sugar Is Not a Poison: The Dietitian’s New Role in Diabetes Management to prepare dietitians for their expanded role in diabetes management. The program has been presented throughout the United States. The curriculum emphasizes skills needed for modern diabetes management, therefore the course is useful for all dietitians who work with people with diabetes.
Other training materials available from the Vanderbilt University DRTC include manuals on interviewing, teaching, and problem-solving and brief videotapes for problem-based patient learning.
The DRTC staff have also developed
- Questionnaires for evaluating the reactions of adults and adolescents with diabetes in situations that challenge adherence to their meal plans and coping strategies.
- The Personal Diabetes Questionnaire (PDQ), a web-based assessment of situations that make patient adherence to self-management recommendations difficult.
- The Self-Monitoring Analysis System (SMAS), a software package for microanalysis of eating behavior.
- Psychological Assessment Applications Generator (PAAG), a software package for developing, administering, scoring, and interpreting psychological tests.
- Assessment tools and teaching aids for promoting diabetes detection, treatment, and prevention in African-American communities.
- Primary Care Management of Diabetes Mellitus, a set of 178 PowerPoint slides for use in teaching health professionals about diabetes. A comprehensive content outline on diabetes, the slide series may be downloaded from the VDRTC’s Internet site.
Contact Steve Davis, M.D. (Director, Prevention/Control and Clincal Research Component), David Schlundt, Ph.D. (Behavioral Health Disparities Core), or James Pichert, Ph.D. (Clinical Outcomes and Behavioral Sciences Core) for information about programs and materials available from the Prevention and Control component of the Vanderbilt University DRTC.
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Washington University’s DRTC Prevention and Control Division
Dr. Edwin B. Fisher directs the Prevention and Control Division of the Washington University DRTC in St. Louis. The Washington University DRTC division is currently involved in many projects designed to improve prevention of and care for people with diabetes.
Current projects at the Washington University DRTC include
- Evaluation and enhancement of care for type 2 diabetes among low-income, minority patients of neighborhood health centers.
- Translation to a Native American community of peer- and community-based approaches to promoting a reduced-fat diet.
- Promotion of exercise among participants in an activity and health program for older adults.
- Study of social support provided by staff in diabetes care and especially in the Diabetes Prevention Program.
Independently funded research projects affiliated with the DRTC also address
- child and family factors in Type 1 diabetes
- depression and diabetes
- use of a peer “coach” to enhance diabetes management in low-income, minority patients with type 2 diabetes
- over 70 active protocols in patient oriented research in diabetes and endocrinology implemented through the Clinical Research Center closely linked with the DRTC
A master’s program in health care services is affiliated with this DRTC. This program for nurses, dietitians, physical and occupational therapists, and other professionals offers interdisciplinary training in health promotion, disease prevention, chronic disease care, patient education and counseling, and program development and evaluation. The curriculum covers programs serving diverse audiences in a variety of settings.
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Diabetes Research and Training Centers Prevention and Control DivisionsHH
Albert Einstein College of Medicine DRTC
Elizabeth A. Walker, D.N.Sc., R.N.
Associate Professor of Medicine
Director, Prevention and Control Division
The Diabetes Research and Training Center
701 Belfer Building
Albert Einstein College of Medicine
1300 Morris Park Avenue
Bronx, NY 10461
Phone: 718–430–2908
Fax: 718–430–8557
Email: walker@aecom.yu.edu
University of Chicago DRTC
Donald Steiner, M.D.
Howard Hughes Medical Institute
University of Chicago
5841 South Maryland Avenue, MC 1028
Room N-216
Chicago, IL 60637
Phone: 773–702–1334
Fax: 773–702–4292
Email: dfsteine@midway.uchicago.edu
Indiana University DRTC
David G. Marrero, Ph.D.
Indiana University School of Medicine
The National Institute for Fitness and Sport
Room 122
250 North University Boulevard
Indianapolis, IN 46202
Phone: 317–278–0905
Fax: 317–278–0911
Email: DMARREO@mdep.iupui.edu
University of Michigan DRTC
Martha Funnell, M.S., R.N., C.D.E.
Michigan Diabetes Research and Training Center
1331 E. Am, Room 5111, Box 0580
University of Michigan Medical School
Ann Arbor, MI 48109–0580
Phone: 734–763–5730
Fax: 734–647–2307
Email: mfunnell@umich.edu
Internet: www.med.umich.edu/mdrtc
Vanderbilt University DRTC
Stephen N. Davis, M.D., F.R.C.P.
Chief, Division of Diabetes, Endocrinology, and Metabolism
Rudolph Kampmeier Professor of Medicine
Professor, Molecular Physiology and Biophysics
Division of Diabetes, Endocrinology, and Metabolism
Vanderbilt University Medical Center
715 PRB, 2220 Pierce Avenue
Nashville, TN 37232–6303
Phone: 615–936–1649
Fax: 615–936–1250
Email: steve.davis@vanderbilt.edu
David G. Schlundt, Ph.D.
Associate Professor of Psychology
Vanderbilt Diabetes Center
315 Medical Arts Building
1211 21st Avenue South
Nashville, TN 37212
Phone: 615–936–1149
Fax: 615–936–1152
Email: David.Schlundt@vanderbilt.edu
James W. Pichert, Ph.D.
Associate Professor of Education in Medicine
Vanderbilt Diabetes Center
315 Medical Arts Building
1211 21st Avenue South
Nashville, TN 37212
Phone: 615–936–1149
Fax: 615–936–1152
Email: Jim.Pichert@mcmail.vanderbilt.edu
Washington University DRTC
Edwin Fisher, Ph.D.
Professor of Psychology, Medicine, and Pediatrics
Division of Health Behavior Research
Washington University
4444 Forest Park Avenue
St. Louis, MO 63108
Phone: 314–286–1900
Fax: 314–286–1919
Email: efisher@im.wustl.edu
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National Diabetes Information Clearinghouse
1 Information Way
Bethesda, MD 20892–3560
Phone: 1–800–860–8747
TTY: 1–866–569–1162
Fax: 703–738–4929
Email: ndic@info.niddk.nih.gov
Internet: www.diabetes.niddk.nih.gov
The National Diabetes Information Clearinghouse (NDIC) is a service of
the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
The NIDDK is part of the National Institutes of Health of the U.S. Department
of Health and Human Services. Established in 1978, the Clearinghouse provides
information about diabetes to people with diabetes and to their families,
health care professionals, and the public. The NDIC answers inquiries, develops
and distributes publications, and works closely with professional and
patient organizations and Government agencies to coordinate resources
about diabetes.
Publications produced by the Clearinghouse are carefully reviewed by both NIDDK scientists and outside experts.
This publication is not copyrighted. The Clearinghouse encourages users of
this publication to duplicate and distribute as many copies as desired.
NIH Publication No. 04–3267
October 2003
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