sdpi demonstration projects grantee meeting june 2008 ihs division of diabetes update kelly acton,...
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SDPI Demonstration Projects Grantee Meeting
June 2008
IHS Division of DiabetesUpdate
Kelly Acton, MD, MPH, FACPDirector
IHS Division of Diabetes Treatment & Prevention
IHS Division of Diabetes Update
Congress extends SDPI funding through FY09
SDPI funding to remain unchanged Year 5 SDPI Demonstration Projects DHHS approval for deviation SDPI Carryover Plan New DDTP website coming 508 compliance issues Highlights from the ADA Scientific
Sessions
SDPI Competitive Grant Program
Original legislation (H.R. 5738 ) extended SDPI through FY08
H.R. 2764 extends SDPI funding through FY09 at $150M per year
Original legislative language still applies (“…to make grants for the purpose of prevention and treatment of diabetes…”)
Congress extends SDPI funding through FY09
SDPI Competitive Grant Program
February 2008: TLDC considers changes to the SDPI program
March 2008: Tribal consultation occurs
March 2008: TLDC decides to recommend that SDPI funding remain unchanged
May 2008: IHS Director accepts TLDC recommendation and decides that SDPI funds will be distributed in the same manner as was done in FY04-08
SDPI funding to remain unchanged
SDPI Competitive Grant Program
Year 5: HH & DP Demo Programs continue to recruit & deliver the interventions
Funding will remain equal to previous years
June 2009: end of intensive data collection; transition to less intensive recruitment & data reporting
Year 5 SDPI Demonstration Projects
SDPI Competitive Grant Program
Feb 2008: DGO/DGP inform DDTP and TLDC that a competitive process is required for compliance with DHHS grants policy
Feb 2008: TLDC strongly requests waiver from competition for one year process
March 2008: DGO/DGP request waiver from DHHS competitive grant policy
April 2008: waiver (“deviation”) granted for FY09 only; will not be allowed if SDPI extended beyond FY09
DHHS approval for deviation
Ideas for Using SDPI Carryover Funds
Carryover Policy
All carryover funds must be used to support the original goals and objectives of the project (prevention and treatment of diabetes)
If the carryover is used during a project extension, the terms and conditions of the award continue to apply to the grantee during the extended period
SDPI Competitive Grant Program
Ideas for Using SDPI Carryover Funds: BackgroundSDPI funds have been targeted at building local /
Tribal program infrastructure for prevention and improved treatment of diabetes
May be a limit to the amount of funds the local infrastructure can efficiently and productively absorb over a given period of time.
Tribes have been good stewards of these resources and have not simply “spent down” funds.
Result is a carryover of congressionally appropriated funds.
One solution to this issue may be to redirect some of these funds to enhance national and regional infrastructure to complement the ongoing efforts directed at local infrastructure and support Tribal efforts to combat diabetes.
SDPI Carryover Plan
SDPI Competitive Grant Program
Ideas for Using SDPI Carryover Funds: Carryover Policy
All carryover funds must be used to support the original goals and objectives of the project (prevention and treatment of diabetes)
If the carryover is used during a project extension, the terms and conditions of the award continue to apply to the grantee during the extended period
SDPI Carryover Plan
SDPI Competitive Grant Program
Feb 2008: DGO/DGP express serious concern to TLDC about SDPI carryover at ~$117M
Feb 2008: TLDC establishes a TLDC Carryover sub-committee
March-April 2008: DGO/DGP and DDTP develop options for carryover use
May 2008: TLDC recommends that carryover funds stay with grantee through September 2008 & training be provided on how to reconcile Payment Mgmt System
May-June 2008: DGO/DGP provide weekly training to grantees via Web-ex
SDPI Carryover Plan
SDPI Competitive Grant Program
July 7, 2008: SF 269 completed & sent to DGO July 7, 2008: SF 272 updated in PMS July 7-31, 2008: Grantees develop carryover
applications August 1, 2008: Carryover applications due to
DGO August 1-31, 2008: Applications reviewed by
DDTP Sept 3-15, 2008: DGO review, approve & issue
modified NOAs Sept 15, 2008: Leftover carryover funds are
considered by TLDC and IHS Director
SDPI Carryover Plan
SDPI Competitive Grant Program
“Incentives” (exercise motivators?)
Medications
Supplies
Training / staff retreats & team re-invigoration
RPMS transfer of data function
Ideas for Spending SDPI Carryover: Demonstration Projects
IHS Division of Diabetes Update
Congress extends SDPI funding through FY09
SDPI funding to remain unchanged Year 5 SDPI Demonstration Projects DHHS approval for deviation SDPI Carryover Plan New DDTP website coming 508 compliance issues Highlights from the ADA Scientific
Sessions
SDPI Competitive Grant Program
Glycemic control & CVD: ACCORD, ADVANCE and the VA Diabetes Trial
Hypoglycemia and MI
Sleep apnea and diabetes
Depression and diabetes
A new model for treating type 2 diabetes
Estimated average glucose (eAG)
Highlights from the ADA Scientific Sessions
SDPI Competitive Grant Program
Impaired insulin secretion
Decreased glucose uptake (insulin resistance)
Increased basal hepatic glucose production
Increased lipolysis (h FFA & lipotoxicity)
Incretin effects (GLP-1 & GIP)
Islet alpha cell glucagon secretion (hyperglucagonemia)
Kidney resorbs glucose in hyperglycemia
brain neurotransmitter dysfunction (impaired appetite regulation & altered hypothalamic function)
Pathophysiology of Diabetes
SDPI Competitive Grant Program
“Old” way: lifestyle + metformin + maybe sulfonylurea
“New” paradigm: preserve maximum beta cell function with lifestyle + metformin + TZD + exenatide (Byetta)
start aggressive treatment early on to get maximum benefit
New Treatment Paradigm for Type 2 Diabetes?
SDPI Competitive Grant Program
Estimated average glucose (eAG)
New international standard of A1C test has been developed that is more precise in measuring glycated hemoglobins. But new test results in a "normal range'' for A1C that is 1.5- 2% lower than the range currently used.
A1C matches estimated average glucose (eAG) in both type 1 and type 2 patients.
ADA and others will begin promoting the use of the term eAG and asking labs to report that value.
Highlights from the ADA Scientific Sessions
SDPI Competitive Grant Program
Estimated average glucose (eAG):
A1C of 6% = eAG of 126 mg/dlA1C of 6.5% = eAG of 140A1C of 7% = eAG of 154A1C of 7.5% = eAG of 169A1C of 8% = eAG of 183A1C of 8.5% = eAG of 197A1C of 9% = eAG of 212A1C of 9.5% = eAG of 226A1C of 10% = eAG of 240
** ADA online calculator at www.diabetes.org/AG
Highlights from the ADA Scientific Sessions
Translating the hemoglobin A1c assay into estimated average glucose values. Nathan D, Kuenen J, Borg R, Zheng H, Schoenfeld D, and Heine RJ, for the A1c-Derived Average Glucose (ADAG) Study Group. Diabetes Care 2008
The Special Diabetes Program for Indians:
On the Path to a Diabetes-free Future
IHS Division of Diabetes Treatment & Prevention
5300 Homestead Rd NEAlbuquerque, NM 87110