UC Mexico Health Initiative: Diabetes Sub-Group
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1 UC Mexico Health Initiative: Diabetes Sub-Group Investigadores: Dr. Dean Schillinger (UC San Francisco) Dr. Marc Schenker (UC Davis) Dr. Carlos Aguilar Salinas (UNAM/INCMN) Dr. Simon Barquera (INSP) Co-investigadores: Mtro. Luis A. Rodriguez Dra. Kirsten Bibbins-Domingo Dra. Martha Kaufer Daniel Elias Lopez Dra. Alicia Fernandez Dra. Margaret Handley Dr. Jorge Salmeron Dr. Juan Rivera Berkeley, California December 1 3, 2016
2 UNDERLYING PRINCIPLES PRINCIPLES/POPULATIONS & PRACTICE Collaboration Autonomy from Industry Vulnerable Populations Cost-Effective Interventions Socio-ecological model Scalable Strong Impact
3 DIABETES SUB-GROUP OBJECTIVES*# Basic Create Platform/Matrix for Collaboration (UC- Mexico studies/investigators)# Build Infrastructure (NIDDK Center)* Resources Short Term Rationale for Collaboration (White Paper)* Diabetes Survey Analyses (Mexico and California)# Health Policy Analyses/Briefs (SSB tax; Conflicts of Interest)*# Descriptive Intermediate Term Longer Term Retinopathy/Nephropathy Projects & Intervention* Trial in post-partum women with GDM* Create & implement innovative counter-marketing campaigns# Social Safety Net (PROSPERA)/Food Bank Interventions# Metformin in primary care# Workplace interventions# Discovery Large- Scale Impact
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6 Conflicts of Interest Symposium Dec 5: Mexico City -Simon Barquera, Alicia Fernandez Focused on COI in diabetes and cardiovascular disease -research -service delivery -policy
7 Develop Counter-Marketing Campaigns with Voices of Youth The Bigger Picture Campaign - UCSF/CVP + Youth Speaks Destapa La Verdad (Dulce Veneno) El Poder del Consumidor, CACTO, La Escuela del Rock a la Palabra
8 Diabetes 2016 Retinopathy study in Morelos, México. Mexico s National Institute of Public Health/ Hospital of the Association to Prevent Blindness in México (Funded by WDF) To develop a screening pilot project for early detection of diabetic retinopathy and chronic disease related to diabetes in adult vulnerable population. Provide evidence to develop a National program to prevent such diseases.
9 Diabetes 2016 Retinopathy study in Morelos, México. Mexico s National Institute of Public Health/ Hospital of the Association to Prevent Blindness in México Screening diagram and study population. No Invitation to participate Glucose screening n= 11,263 Altered glucose or diabetes * Tepoztlán n= 4,687 Xochitepec n= 4,073 Emiliano Zapata n= 2,503 Yes Healthy lifestyle recommendation s Ocular evaluation + blood sample + questionnaire** No Retinopathy, glaucoma, AMD a Yes Referred for treatment 9
10 Diabetes 2016 Retinopathy study in Morelos, México. n= 8,383 Proportion of people with diabetes and prediabetes n= 2,920 (34.83%) Impaired fasting glucose New cases of diabetes Diabetes cases without IFG Diabetes cases with IFG 10
11 Diabetes 2016 Chronic kidney disease study. Mexico s National Institutes of Public Health and Nutrition. Funded by Gonzalo Río Arronte Foundation. Chronic kidney disease study. National prevalence of chronic kidney disease and an educational intervention in subjects with high cardiometabolic risk to prevent kidney failure. National prevalence: National Health and Nutrition Survey 2016 Low-cost intervention that allows the patient to selfmanage their condition. 11
12 Workplace Interventions (Marc) for Mexican-American Farm Workers 12
13 Nutrition and diabetes 2016 PREVENT Trial A remarkable collaboration with the Mexco City Ministry of Health Research question: Is metformin therapy a viable, effective and cost-effective intervention to decrease the incidence of type 2 diabetes in low income adult subjects with obesity and prediabetes in Mexico City? Objective: Decrease the incidence of type 2 diabetes in high-risk subjects through a strategy consisting of a lifestyle intervention with and without metformin, via community-based primary care and adherence support (over 3 years). 13
14 Nutrition and diabetes 2016 PREVENT trial. Recruitment/Al location Intervention Follow up 3 years Outcomes Subjects with obesity and prediabetes in 26 clinics. Lifestyle changes (13 clinics) Lifestyle changes + metformin (13 clinics). Promotores m-health -Time to diabetes (survival analysis). -Change in HbA1c. -Costs of care. -Change in lifestyle. -Adherence (MTF) 14
15 CHALLENGES Securing intramural funding to support the collaboration Securing extramural funding to support individual projects Developing truly bi-national projects Expanding our stakeholders in CA and Mexico to change structural determinants Especially policy
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