Considerations for Diabetes Translational Research in Real-World Settings
- Sanford A. Garfield, PHD1,
- Saul Malozowski, MD, PHD, MPH1,
- Marshall H. Chin, MD, MPH2,
- K.M. Venkat Narayan, MD3,
- Russell E. Glasgow, PHD4,
- Lawrence W. Green, MD3,
- Roland G. Hiss, MD5,
- Harlan M. Krumholz, MD6 and
- Diabetes Mellitus Interagency Coordinating Committee (DMICC) Translation Conference Working Group
- 1Division of Endocrinological and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
- 2Department of Medicine, University of Chicago, Chicago, Illinois
- 3Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
- 4Clinical Research Unit, Kaiser Permanente, Canon City, Colorado
- 5Department of Medical Education, University of Michigan, Ann Arbor, Michigan
- 6Department of Medicine, Yale School of Medicine, New Haven, Connecticut
- Address correspondence and reprint requests to Sanford A. Garfield, PhD, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892-5460. E-mail: garfields{at}extra.niddk.nih.gov
- DCCT, Diabetes Control and Complications Trial
- DPP, Diabetes Prevention Program
- NIDDK, National Institute of Diabetes and Digestive and Kidney Diseases
- UKPDS, U.K. Prospective Diabetes Study
“IDDK’s mission is to conduct and support research on diseases such as diabetes in order to increase knowledge to improve
the public’s health. NIDDK’s goals will not be completely achieved until the knowledge gained from the research it supports
is translated and fully applied.”
—Allen Spiegel, MD, Director, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), 27 September 2002
(1).
Tremendous advances have occurred in diabetes research over the past decade. Landmark clinical trials such as the Diabetes Control and Complications Trial (DCCT) and U.K. Prospective Diabetes Study (UKPDS) have demonstrated that tight glycemic and blood pressure control reduce the rate of complications (2,3,4). More recently the Diabetes Prevention Program (DPP) showed that lifestyle interventions incorporating healthy diets and exercise, as well as treatment with the drug metformin, delay or prevent the development of diabetes in people with impaired glucose tolerance (5). Armed with such knowledge, health care providers and public health professionals have the potential to prevent morbidity and enhance quality of life in a cost-effective manner (6).
Unfortunately, little of this potential has been realized. Numerous studies in a variety of settings indicate that real-world diabetes care frequently does not adhere to evidence-based practice standards for glycemic, blood pressure, and lipid levels and for providing recommended processes of care such as the Diabetes Quality Improvement Project indicators (7,8). The challenges of adhering to recommendations regarding diet, physical activity, medications, and other medical care are formidable. A complex array of social, financial, behavioral, and organizational barriers impede the application of high-quality diabetes care. These multifactorial barriers can be daunting, but significant advances have occurred in learning how to translate research findings from the clinical research setting into real-world practice.
In September 2002 the Diabetes Mellitus Interagency Coordinating Committee, which …
