New UNC Center for Diabetes seeks to reduce health disparities
The University of North Carolina at Chapel Hill has received a $3 million, 5-year grant from the National Institute of Diabetes and Digestive and Kidney Diseases to establish the UNC Center for Diabetes Translation Research to Reduce Health Disparities (CDTR). Its mission is to reduce diabetes-related disparities among poor and underserved populations by providing resources and support to foster translational research in North Carolina and beyond. The center’s research will examine and compare different techniques for bringing effective preventive and therapeutic interventions into practice.
Currently, 1 in 9 adults in the U.S. (about 264 million) has type 2 diabetes. If trends continue, projections suggest that 1 in 3 people may have the condition by 2050. Diabetes-related annual costs are currently $174 billion and may increase to $336 billion by 2034. Poor, minority and rural populations with limited access to health care suffer disproportionately. Especially in North Carolina, African-American, Hispanic and Native American populations have a higher rate of diabetes and related complications.
One of seven such centers in the nation established by the National Institutes of Health -- and one of only two that do not already have a concurrent NIH-funded diabetes research center -- the UNC CDTR will share resources and encourage collaboration on research that moves further along the translational continuum. That is, it will work to get improved treatments applied in communities and validate that they make a difference. This critical step adds to the wealth of diabetes care and research already at UNC by over 200 researchers working on $350 million in funding since 2000.
The UNC CDTR will leverage existing resources at the North Carolina Translational and Clinical Sciences (NC TraCS) Institute, home of UNC’s NIH Clinical and Translational Science Awards (CTSA). NC TraCS is part of a national consortium whose mission is to accelerate movement of research discoveries into patient therapies and community interventions. The UNC CDTR also will partner with UNC-Pembroke, Robeson County Health Department, Wake Forest University and East Carolina University.
The co-directors are Richard Davis, MD, and Michael Pignone, MD, MPH.
“The UNC CDTR is an example of how proposed new centers can leverage existing NC TraCS resources to enhance their proposals. Going forward the center will continue to rely on NC TraCS to help us more quickly translate research findings into better diabetes prevention strategies and treatments,” said Davis. “Our goal is improved health outcomes with regard to diabetes, not just in North Carolina but nationally.”
“There’s always room for discovery of new and more effective therapies, but we have a lot of good therapies now that aren’t being well-utilized across the whole population, particularly in the more vulnerable patient populations,” added Pignone. “This center and its partners around the country are set up to try to accelerate the pace of translation into practice … and also to understand the science of how to translate more effective therapies into practice.”
Davis, an ophthalmologist with expertise in the use of telemedicine and telehealth to support community translational research, will lead efforts to utilize technologies to improve health outcomes through his direction of the "access with technology core." He also will direct the administrative core.
“A lot of rural counties don’t have access to diabetes educators or registered diabetes dieticians,” said Davis. He went on to explain how the access to technology core’s goal is to assist researchers or interventionists in using technology to connect patients and the community with those experts in remote locations.
Pignone, chief of the division of general medicine with expertise in developing novel means for improving chronic illness prevention and care, will lead a nationally designated resource center to study and improve literacy and numeracy in diabetes. Problems with literacy and numeracy are common, and less-literate and numerate patients have more difficulty managing diabetes, in particular, because of the high demands the condition places for tracking food intake, monitoring blood sugar levels and following complex medication regimens.
Pignone sees the national resource center as providing investigators, for example, with a suite of measurement tools, questionnaires about literacy and numeracy or questionnaires that have been shown to be appropriate for low-literacy audiences for use in their translational diabetes research. He said the center also will enable experienced UNC researchers to consult with interventionists as they design more effective interventions for treatment of diabetes in populations with lower levels of literacy and numeracy.
“It’s going to give us a chance to have an even wider impact on literacy- and numeracy-related health disparities, which is something near and dear to my heart,” said Pignone.
Beth Mayer-Davis, Ph.D., of the UNC departments of nutrition and medicine, has worked in diabetes research for 20 years and will lead the CDTR pilot study program, which will fund new projects each year (read her profile in this issue). Its goal is to foster translational research in diabetes among junior investigators and to encourage senior investigators to bring their skills from working in other health issues to bear on diabetes. The study section that will make recommendations about which pilot studies receive funding will be a combination of CDTR and CTSA members.
Alice Ammerman, Dr.P.H., a nutritionist who directs the UNC Center for Health Promotion and Disease Prevention, a CDC-funded prevention research center, will lead efforts to connect the UNC CDTR with communities where health disparities exist. Efforts will include involving community members in diabetes research and working closely with UNC-Pembroke and the Robeson County Health Department.
Ammerman already is a leader in forging academic-community connections through NC TraCS’s Community Engagement Core. Davis, an NC TraCS research navigator, guides other researchers through the processes of applying for research funding and accessing resources to complete their projects. Pignone has been involved with the development of diabetes care guidelines for the American Diabetes Association, American Heart Association and the National Committee on Quality Assurance in Health Care.
“One of the reasons why we can be particularly effective here in North Carolina is that we have a rich tradition of doing translational research in the community and really strong academic, public-sector and private-sector partnerships. I think we are very well positioned to be a catalyst for both translating diabetes care into practice and for studying the best ways for doing that,” said Pignone.
Adapted from UNC Health Care News, September 29, 2011