EPID 712/DIABETES EPIDEMIOLOGY. Monday Friday/8:30 AM to 12:00 Noon/Room and Building

Transcription

1 EPID 712/DIABETES EPIDEMIOLOGY Monday Friday/8:30 AM to 12:00 Noon/Room and Building Professor: Coordinator: William H. Herman, MD, MPH (734) Office Hours: By Appointment Laura McEwen, PhD Office Hours: By Appointment Course Description: Course Materials: Pre requisites: Course Goals: Competencies: This course will focus on diabetes epidemiology through both lecture and interactive student led discussions. Topics will include diagnosis and classification, risk factors and projections of disease burden, screening for diabetes, the evidence base for diabetes prevention, monitoring and management of glycemia, management of cardiovascular risk factors, microvascular and neuropathic complications, cardiovascular complications, mortality, and landmark observational studies and randomized, controlled, clinical trials evaluating the impact of treatment on complications. Time permitting, a session will focus on diabetes computer simulation modeling to address the impact of treatments on complications, costs, and quality of life. Although focused on obesity and diabetes, the course will illustrate important general principles in chronic disease epidemiology. There is no text book for this course. Journal articles will be assigned for each topic. Students are expected to review these before each class. Students should have a basic knowledge of epidemiology. The student will understand issues related to: diagnosis and classification risk factors and current and future disease burden screening for and prevention of type 2 diabetes microvascular and neuropathic complications of diabetes cardiovascular (CV) risk factors and CV disease in diabetes treatment of diabetes, its complications and comorbidities translating interventions into community practice diabetes computer simulation modeling The student will learn: methodological issues related to diagnosing a chronic disease why, when, who, where, and how to screen for diabetes the advantages and disadvantages of primary, secondary, and tertiary interventions for diabetes 1

2 the challenges of conducting randomized controlled clinical trials in diabetes the barriers to translating knowledge from clinical trials into community practice the rationale for and limitations to chronic disease computer simulation modeling Course Requirements: The course will involve lectures, classroom discussions, student presentations, and a multiple choice final exam. The course grade will be determined by: Attendance 20% Participation 30% Quality of presentation 30% Final exam 20% 100% Student presentations will be evaluated based on clarity of presentation of the background and research questions, methods, and results and the discussion of the implications of the results of the research including the limitations and generalizability of the results. Classroom Expectations/Etiquette: Students are expected to attend all classes and to actively participate in class discussions. Academic Integrity: The faculty and staff of the School of Public Health believe that the conduct of a student registered or taking courses in the School should be consistent with that of a professional person. Courtesy, honesty, and respect should be shown by students toward faculty members, guest lecturers, administrative support staff, and fellow students. Similarly, students should expect faculty to treat them fairly, showing respect for their ideas and opinions and striving to help them achieve maximum benefits from their experience in the School. Student academic misconduct refers to behavior that may include plagiarism, cheating, fabrication, falsification of records or official documents, intentional misuse of equipment or materials (including library materials), and aiding and abetting the perpetration of such acts. Please visit for the full SPH Code of Academic Integrity and further definition of these terms. Student Well being: SPH faculty and staff believe it is important to support the physical and emotional well being of our students. If you have a physical or mental health issue that is affecting your performance or participation in any course, and/or if you need help connecting with University services, please contact the instructor or the Office of Academic Affairs. Please visit for more information. Student Accommodations: Students should speak with their instructors before or during the first class regarding any special needs. Students can also visit the Office of Academic Affairs for assistance in coordinating communications around accommodations. 2

3 Students seeking academic accommodations should register with Services for Students with Disabilities (SSD). SSD arranges reasonable and appropriate academic accommodations for students with disabilities. Please visit for more information on student accommodations. Students who expect to miss classes, examinations, or other assignments as a consequence of their religious observance shall be provided with a reasonable alternative opportunity to complete such academic responsibilities. It is the obligation of students to provide faculty with reasonable notice of the dates of religious holidays on which they will be absent. Please visit for the complete University policy. 3

4 Course Outline MONDAY, July 10, 2017 Introduction Diagnosis and classification of diabetes in nonpregnant adults Gestational diabetes mellitus Risk factors for diabetes The current and future global burden of diabetes TUESDAY, July 11, 2017 Screening for diabetes The evidence base for type 2 diabetes prevention WEDNESDAY, July 12, 2017 Levels of prevention Primary prevention Secondary intervention Tertiary intervention The Epidemiology of diabetes complications and comorbidities Acute complications Microvascular and neuropathic complications Cardiovascular risk factors and cardiovascular comorbidities Mortality THURSDAY, July 13, 2017 Therapeutic targets in diabetes Obesity o Lifestyle treatments: population vs. high risk (targeted) o Pharmacologic therapies o Surgical therapies Glycemia o Lifestyle treatments o Pharmacologic therapies Blood pressure Lipids Platelets/thrombosis Complication specific therapies o Retinopathy o Nephropathy o Neuropathy o Cardiovascular disease 4

5 FRIDAY, July 14, 2017 Challenges in translating research into practice: access to care, disparities, and health care delivery Student presentations: Controversies in diabetes epidemiology How should we diagnose gestational diabetes mellitus? 1. International Association of Diabetes and Pregnancy Study Groups Consensus Panel., Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, Dyer AR, Leiva Ad, Hod M, Kitzmiler JL, Lowe LP, McIntyre HD, Oats JJ, Omori Y, Schmidt MI. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010;33(3): Vandorsten JP, Dodson WC, Espeland MA, Grobman WA, Guise JM, Mercer BM, Minkoff HL, Poindexter B, Prosser LA, Sawaya GF, Scott JR, Silver RM, Smith L, Thomas A, Tita AT. NIH consensus development conference: diagnosing gestational diabetes mellitus. NIH Consens State Sci Statements 2013;29(1):1 31. What is the best real world approach to preventing type 2 diabetes? 1. Pronk NP, Remington PL; Community Preventive Services Task Force. Combined diet and physical activity promotion programs for prevention of diabetes: Community Preventive Services Task Force Recommendation Statement. Ann Intern Med 2015;163: Ackermann RT. Diabetes Prevention at the tipping point: aligning clinical and public health recommendations. Ann Intern Med 2015;163: Jackson SL, Long Q, Rhee MK, Olson DE, Tomolo AM, Cunningham SA, Ramakrishnan U, Narayan KM, Phillips LS. Weight loss and incidence of diabetes with the Veterans Health Administration MOVE! lifestyle change programme: an observational study. Lancet Diabetes Endocrinol 2015;3: Wareham NJ. Mind the gap: efficacy versus effectiveness of lifestyle interventions to prevent diabetes. Lancet Diabetes Endocrinol 2015;3: Moin T, Li J, Duru OK, Ettner S, Turk N, Keckhafer A, Ho S, Mangione CM. Metformin prescription for insured adults with prediabetes from 2010 to 2012: a retrospective cohort study. Ann Intern Med 2015;162: How should glycemia be monitored in diabetes? 1. Herman WH. Are there clinical implications of racial differences in HbA1c? Yes, to not consider can do great harm! Diabetes Care 2016;39: Selvin E. Are there clinical implications of racial differences in HbA1c? A difference, to be a difference, must make a difference. Diabetes Care 2016;39: How low should we go? blood pressure targets in type 2 diabetes 1. ACCORD Study Group., Cushman WC, Evans GW, Byington RP, Goff DC Jr, Grimm RH Jr, Cutler JA, Simons Morton DG, Basile JN, Corson MA, Probstfield JL, Katz L, Peterson KA, Friedewald WT, Buse JB, Bigger JT, Gerstein HC, Ismail Beigi F. Effects of intensive blood pressure control in type 2 diabetes mellitus. N Engl J Med 2010;362(17):

6 2. SPRINT Research Group., Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, Rocco MV, Reboussin DM, Rahman M, Oparil S, Lewis CE, Kimmel PL, Johnson KC, Goff DC Jr, Fine LJ, Cutler JA, Cushman WC, Cheung AK, Ambrosius WT. A randomized trial of intensive versus standard blood pressure control. N Engl J Med 2015;373:

7 Course Readings Introduction Zimmet PZ, Magliano DJ, Herman WH, Shaw JE. Diabetes: a 21st century challenge. Lancet Diabetes Endocrinol 2014;2: Diagnosis and classification of diabetes in nonpregnant adults Herman WH, Wareham NJ: The diagnosis and classification of diabetes mellitus in nonpregnant adults. Primary Care: Clinics in Office Practice 1999; 26: American Diabetes Association. 2. Classification and diagnosis of diabetes. Diabetes Care 2017;40(Suppl 1):S11 S24. Gestational diabetes mellitus Carpenter MW, Coustan DR. Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol 1982;144: HAPO Study Cooperative Research Group., Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, Hadden DR, McCance DR, Hod M, McIntyre HD, Oats JJ, Persson B, Rogers MS, Sacks DA. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med May 8;358(19): American Diabetes Association. 13. Management of diabetes in pregnancy. Diabetes Care 2017;40(Suppl 1):S114 S119. Risk factors for diabetes American Diabetes Association. 2. Classification and Diagnosis of Diabetes. Diabetes Care 2017;40(Suppl 1):S11 S24. The current and future burden of diabetes Menke A, Casagrande S, Geiss L, Cowie CC. Prevalence of and trends in diabetes among adults in the United States, JAMA Sep 8;314(10): Herman WH, Rothberg AE. Prevalence of diabetes in the U.S.: a glimmer of hope? JAMA 2015;314: King H, Aubert RE, Herman WH: Global burden of diabetes, : prevalence, numerical estimates and projections. Diabetes Care 1998;21: Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and Diabetes Res Clin Pract 2010;87:4 14. Screening for diabetes Engelgau MM, Venkat Narayan KM, Herman WH: Screening for type 2 diabetes. Diabetes Care 2000; 23: Tabaei BP, Burke R, Constance A, Hare J, May Aldrich G, Parker SA, Scott A, Stys A, Chickering J, Herman WH: Community based screening for diabetes in Michigan. Diabetes Care 2003;26: McEwen LN, Adams SR, Schmittdiel JA, Ferrara A, Selby JV, Herman WH. Screening for impaired fasting glucose and diabetes using available health plan data. J Diabetes Complications 2013;27: Johnson SL, Tabaei, BP, Herman WH. The efficacy and cost of alternative strategies for systematic screening for type 2 diabetes in the US population years of age. Diabetes Care 2005;28: