This Funding Opportunity Announcement (FOA) invites applications that propose a Center for Diabetes Translation Research (CDTR) to advance research along the spectrum of diabetes T2-T4 translational research (i.e., bedside to clinical practice and community settings, dissemination and implementation). The purpose of this Centers program is to accelerate innovation of diabetes translation to maximize positive impacts of research on population health through activities and core services that offer specialized expertise, tools, education, and support. An emphasis on novel methods and research to address health equity and reduce diabetes-related health disparities is encouraged. Novel research cores designed to improve other aspects of person-centered, community, and population health are also encouraged with justification for how such strategies may be adapted to meaningfully inform disparity-reduction approaches. A scientific base reflecting academic institutions and diverse organizational collaborators (e.g., healthcare systems, community organizations, health departments, human services) is expected to foster a Center framework necessary for improving population health. CDTRs are based on the core concept whereby shared resources aimed at fostering productivity, synergy, and novel research ideas among the funded investigators are supported in a cost-effective manner.
Diabetes is a common chronic disease that imposes considerable demands on affected individuals, communities, and healthcare system resources. People with diabetes have a higher rate of cardiovascular disease than those without diabetes and are at increased risk for microvascular complications that may lead to kidney failure, lower limb amputation, and blindness. Obesity is a significant risk factor for type 2 diabetes and the prevalence of obesity in adults and children in the U.S. has dramatically increased in the past four decades. Overweight, obesity, and/or excessive weight gain during pregnancy are also contributing to the rising rates of gestational diabetes mellitus (GDM) which in turn increases risk of future type 2 diabetes in the mother and child. Both type 1 and type 2 diabetes in youth are on the rise. Aging is also a risk factor for type 2 diabetes, and one in four nursing home patients have diabetes.
Diabetes currently affects an estimated 34.2 million people in the U.S. Another 88 million Americans aged 20 years or older are estimated to have prediabetes. The CDC estimates that one in three American children born in 2000 will develop diabetes at some point in their lives. The total estimated cost of diagnosed diabetes in 2017 was $327 billion, including $237 billion in direct medical costs and $90 billion in reduced productivity.
Large clinical trials clearly demonstrate that glycemic control and cardiovascular risk factor modification can reduce risk of complications in both type 1 and type 2 diabetes. Although there have been considerable improvements in diabetes treatment options and in risk-factor control over the past three decades, research demonstrates that many individuals with diabetes (youth and adults) do not meet recommended goals for diabetes care. It is also well established that behavioral lifestyle interventions, with modest (5-7%) weight loss, can prevent or delay development of type 2 diabetes in individuals at high risk for the disease and, in individuals who already have type 2 diabetes, can decrease sleep apnea, reduce the need for diabetes medications, help maintain physical mobility, and improve quality of life.
Despite these advances, there remains a gap between the evidence and real-world diabetes prevention and treatment. The gap is particularly evident in many racial and ethnic minority populations and for individuals living in poverty or low resourced environments. Although diabetes occurs in all populations in the U.S., obesity, type 2 diabetes, and diabetes complications disproportionately impact U.S. racial and ethnic minority communities and low-income populations across the lifespan. High-burden populations with low socioeconomic status (SES), living in rural areas and low-resourced communities bear a disproportionate burden of illness related to these conditions compared with non-Hispanic Whites and those with high SES. Research indicates that fundamental causes of health inequities are rooted in adverse social determinants of health (SDH), which are defined by the World Health Organization as “conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life” https://www.who.int/social_determinants/sdh_definition/en/. These influences result in avoidable differences in health among populations requiring interventions at the person, healthcare system, community, population, and policy levels. A central challenge in improving population health is translating efficacious interventions conducted in well-resourced research conditions into real-world settings. Tailored approaches to address health inequities are expected to vary according to the different contextual levels and interventions involved. For example, challenges in effectively scaling-up successful interventions and reaching at-risk populations may require novel partnerships that extend beyond traditional clinical services to community contexts and non-healthcare sector organizations with missions that directly involve addressing SDH or assisting individuals overcome the negative impacts of SDH. The research opportunities include, but are not limited to, understanding the best strategies to address socioecological, economic ,and other environmental conditions that perpetuate disparities in the burden of diabetes and related conditions; designing effective prevention and treatment strategies that are accessible, feasible, culturally relevant, and acceptable to diverse populations and communities; and achieving sustainable health improvement approaches in communities with the greatest burden of diabetes and associated risk factors.
Closing the gap in holistic diabetes care and improving health equity will require diabetes T2-T4 translational research (i.e., bedside to clinical practice and community settings, dissemination and implementation) for testing innovation adaptations of evidence-based approaches to prevent and treat diabetes. Additionally, such interventions should be designed to be disseminated and sustained both behaviorally and economically in routine clinical healthcare practice, community settings, and nontraditional healthcare contexts. Multidisciplinary and diverse organizational collaborations are deemed important to foster the dynamic capacity and research framework necessary for improving health equity and population health.
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