The Science of Diabetes Self-Management and Care2023, Vol. 49(4) 317 –318© The Author(s) 2023Article reuse guidelines:sagepub.com/journals-permissionsDOI: 10.1177/26350106231169691journals.sagepub.com/home/tde
Since 1977, Diabetes Research and Training Centers (DRTCs) and, more recently, Centers for Diabetes Translational Research (CDTRs) played a foundational role in the nation’s efforts to translate advances in diabetes research into improved outcomes for people with diabetes. With many certified diabetes education specialists playing critical roles in the DRTCs and CDTRs over the years, the impact of diabetes translational research on the Association of Diabetes Care & Education Specialists (ADCES) is significant. It enhanced professional development of ADCES members, led to the development of new and innovative management and treatment options, enabled certified diabetes education specialists to provide personalized management approaches, and supported certified diabetes education specialists working to the extent of their licensures. Over the years, diabetes translational research evolved from health-system-centric patient education, team care, and model care delivery to regional, national, and international approaches that target patients, certified diabetes care and education specialists, providers, practices, health systems, and communities. Indeed, researchers from the University of Michigan CDTR made significant contributions to the science and practice of using nontraditional, complex study designs to evaluate and improve diabetes prevention, management, and self-management support programs; the development and implementation of the empowerment approach to diabetes education; new measurements to assess knowledge, provider attitudes, and patient empowerment; establishment of the cost-effectiveness of diabetes selfmanagement education and support and other novel programs; and the design and evaluation of innovative intervention strategies, tools, and platforms to improve individual and population health.
To address the progression of diabetes translational science, in 2020, the CDTRs refocused their programs to provide specialized expertise and resources to raise awareness of, interest in, and successful execution of rigorous translational diabetes research focused on improving health equity for people with and at risk for developing diabetes. Although landmark trials established the scientific basis for diabetes prevention and management and significant progress was made in decreasing the gaps between optimal care and the care delivered in everyday clinical practice, the public health impact of these efforts remains unrealized. The continued disproportionate disease burden that faces health care systems, nationwide and globally, is largely attributable to several factors, including systemic differences in health that are avoidable, unjust, and related to social and economic disadvantage.
Glaring disparities persist by race/ethnicity, education, income, and geography in prevalence, morbidity, and mortality from diabetes and other cardiometabolic conditions.1,2 There are steep inverse gradients in diabetes prevalence, complications, and mortality with education and poverty.3,4 Geographic variations are striking, with area-level poverty standing out as the strongest single predictor of being a high-risk county.5 These political, environmental, social, behavioral, and economic factors, often called “social and behavioral determinants of health (SBDOH),: significantly shape individual behavioral risk factors such as dietary patterns, levels of physical activity, medication engagement, and smoking that increase risks of diabetes and its complications.6-8 Most, if not all, SBDOH that lead to disparities are modifiable, including the built environment of a neighborhood. Undeniably, in many cases, a zip code is a stronger predictor of health than DNA.
Park et al9 provide one of the most cited and read research articles in The Science of Diabetes Self-Management and Care. [Click this link to access article: https://journals.sagepub.com/doi/10.1177/0145721720906082] The 2020 article is an example of the progression of diabetes translational science over the last 5+ years with a movement toward achieving health equity for people with diabetes by addressing SBDOH. In this case, the authors use an emergent design to address issues of health equity and SBDOH by exploring the influences of the neighborhood environment on physical activity for African American adults with type 2 diabetes in a southwest Baltimore community. Rich qualitative data from patients and providers demonstrated that the physical environment in southwest Baltimore and similar communities, nationwide, perpetuates inequitable access to physical activity for individuals with diabetes. Not only do individuals in these neighborhoods face social and economic stressors, but their neighborhoods lack the infrastructure (well-lit streets with sidewalks, access to recreational facilities, and social support) needed for them to engage in physical activity as part of their diabetes self-management plan.
Just as the DRTCs and CDTRs serve(d) as a conduit to improving diabetes prevention and management over the years, they will continue to promulgate interventions and policies, at multiple levels of scale, influencing SBODH, including neighborhood resources that are essential to improve equitable access to physical activity and other diabetes self-management behaviors.
Dr Gretchen Piatt is an associate professor and vice chair of the Department of Learning Health Sciences at the University of Michigan School of Medicine. Additionally, she serves as the co-director of the Michigan Center for Diabetes Translational Research. She has expertise in implementing, designing, and evaluating community interventions aimed at improving health care delivery for individuals with diabetes who are from backgrounds underrepresented in biomedical and behavioral research. She leads research teams that design and evaluate interventions in the primary and secondary prevention of diabetes and its complications, including implementation and evaluation of self-management support interventions in underresourced communities, federally qualified health centers, and primary care. Dr Piatt has served on the ADCES research committee since 2021 and was instrumental in constructing the current ADCES research agenda.
None reported.
Gretchen A. Piatt https://orcid.org/0000-0001-6641-6330
From Department of Learning Health Sciences, University of Michigan School of Medicine, Ann Arbor, Michigan (Dr Piatt).
Corresponding Author:Gretchen A. Piatt, Department of Learning Health Sciences, University of Michigan School of Medicine, 1111 East Catherine St, Victor Vaughan Room 225, Ann Arbor, MI 48109, USA.Email: Piattg@umich.edu
