The Impact of Diabetes on Global Heart Health

Transcription

1 The Impact of Diabetes on Global Heart Health George A. Mensah, M.D. Director Center for Translation Research and Implementation Science (CTRIS) National Heart, Lung, and Blood Institute, NIH Bethesda, Maryland Presented at the AHA Scientific Sessions CVS-204 Diabetes Epidemic: The Global Impact on Cardiovascular Health November 16, 2014

2 Disclosure and Disclaimer Statements No conflicts to disclose. The contents of this presentation should not be construed as representing an official position of the National Institutes of Health (NIH) or the Department of Health and Human Services. Center for Translation Research and Implementation Science (CTRIS)

3 OUTLINE The Global Burden of Diabetes The Link to Global Heart Health A Role for Implementation Research Center for Translation Research and Implementation Science (CTRIS)

4 OUTLINE The Global Burden of Diabetes The Link to Global Heart Health A Role for Implementation Research Center for Translation Research and Implementation Science (CTRIS)

5 Diabetes is a huge and growing problem, and the costs to society are high and escalating

6 The 2014 Update of the IDF Atlas Data Shows Diabetes Burden Continues to Grow

7 Global Burden of Metabolic Risk Factors for Chronic Diseases Collaboration Majid Ezzati Imperial College London Goodarz Danaei Harvard School of Public Health Center for Translation Research and Implementation Science (CTRIS)

8 Over the last 30 years, the mean FPG has increased in most regions of the world Danaei et al. Lancet 2011; 378: Trends in age-standardized mean FPG by region between 1980 and 2008 for men (A) and women (B)

9 Over the last 30 years, diabetes prevalence has increased in most regions of the world Danaei et al. Lancet 2011; 378: Trends in age-standardized diabetes prevalence by region between 1980 and 2008 for men (A) and women (B

10 Attributable Deaths from Four Risk Factors Courtesy of Majid Ezzati, Imperial College London

11 Contributions of High BMI, FPG, and Other Risk Factors to Attributable Deaths, 1980 & 2010 Courtesy of Majid Ezzati, Imperial College London

12 OUTLINE The Global Burden of Diabetes The Link to Global Heart Health A Role for Implementation Research Center for Translation Research and Implementation Science (CTRIS)

13 Mechanisms in the pathogenesis of cardiovascular diseases in diabetes Matheus et al. Int J Hypertens 2013;

14 Complications of Diabetes Modified; courtesy of Mo Ali, Emory University, Rollins School of Public Health

15 Adjusted cumulative incidence Lifetime Risk for CHD 0.7 Men 0.7 Women % % Attained Age Lloyd Jones et al Circ 2006;113:791

16 Adjusted cumulative incidence Diabetes & Lifetime Risk for CHD 0.1 Men 67% 30% Women Diabetic Non Diabetic 57% Diabetes confers the highest lifetime risk for CHD of any single risk factor. 16% Attained Age Lloyd Jones et al Circ 2006;113:791

17 CHD Events Prevented Over 10 Years in US Adults with T2DM, According to Individual and Composite Risk Factor Wong et al. Am J Cardiol 2014;113:1356e1361

18 OUTLINE The Global Burden of Diabetes The Link to Global Heart Health A Role for Implementation Research Center for Translation Research and Implementation Science (CTRIS)

19 Pronovost P, et al. AJCCM 2010;182(12): Dorsey ER, et al. JAMA 2010;303: Investments in Biomedical Research: A Fraction for Dissemination and Implementation Research For every dollar the Federal Government spends on traditional biomedical research, it spends 2 pennies on research to ensure that patients actually receive the interventions identified through biomedical research

20 The fraction of discovery science reaching patients in clinical practices is very low Westfall et al. Practice-based research-- "Blue Highways" on the NIH roadmap JAMA Jan 24;297(4): It takes an average of 17 years for only 14% of new scientific discoveries to enter day-to-day clinical practice. Americans receive, on average, only half of recommended preventive, acute, and long-term quality health care. Balas and Boren, 2000 (for bullet 1) McGlynn et al. NEJM 2003;348: (for bullet 2)

21 Clinical Research to Clinical Practice: Lost in Translation? And it is not just recent research results that are not finding their way into clinical practice and public health behaviors; there is plenty of evidence that old research outcomes have been lost in translation as well. Lenfant. N Engl J Med. 2003;349:868-74

22 A Focus on T4 Translation Research Biomedical Model Biomedical and Socioecological Model Bench Research Bedside Patients Practices Real World Setting Fundamental Discovery Science Animal Studies 1 st Human Studies Controlled Observations Phase I Clinical Trials Phase II and III Clinical Trials Phase IV Clinical Trials Comparative Effectiveness Research Dissemination and Implementation Research Discovery Science T1 Translation to Humans T2 Translation to Patients T3 Translation to Clinical Practices T4 Translation to Real World Settings Mensah. Global Heart September 2013;8(3):

23 NHLBI partnered with NCI, OBSSR, ODP, NIMH, NIDDK, and the VA to co-fund TIDIRH 2014 Conducted at Harvard University. Designed as a 5-day training institute to provide participants with a thorough grounding in conducting dissemination and implementation research in health. Designed for investigators at any career stage interested in conducting D&I research. CTRIS - Center for Translation Research and Implementation Science

24 The 7 th Annual Conference on the Science of Dissemination and Implementation Transforming Health Systems to Optimize Individual and Population Health December 8-9, 2014 Bethesda North Marriott Hotel & Conference Center Co-hosted by: Co-sponsors: AHRQ, PCORI, VA, and RWJ Foundation

25 Translational and Clinical Sciences Time for a New Vision Elias Zerhouni, Former NIH Director It is the responsibility of those of us involved in today's biomedical research enterprise to translate the remarkable scientific innovations we are witnessing into health gains for the nation. Zerhouni. N Engl J Med 2005; 353:

26 Reduce the Impact of Diabetes on Global Cardiovascular Health Source: International Diabetes Federation

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