In our July issue, Dr. Roland Hiss presented the paradigm of the Michigan Diabetes Research and Training Center’s (DRTC’s) approach to the difficulties and opportunities of translating the results of clinical studies into clinical practice (1). As the DRTCs reach their 25th anniversary, it seems appropriate to review their progress in understanding and improving the translation of clinical trials into clinical practice. I have asked the coordinators of translation research of the six DRTCs to briefly summarize their approaches and successes in this area, which follow.

It is important to note that the DRTCs began in 1977 in an environment where we knew that there were huge gaps between the results of clinical trials and clinical practice, but we knew little about why those gaps existed, nor did we know how to close them. In large measure our progress in translation research and our successes in translating the subsequent landmark clinical trials into practice are and will continue to be a result of the research conducted by the DRTCs. All of the DRTCs have made vital contributions to this area of research. We present their experiences in alphabetical order.

Marshall H. Chin, MD, MPH, Associate Professor of Medicine.

The University of Chicago’s DRTC Demonstration and Education (D&E ) cores have focused on developing provider-, patient-, and systems-level interventions to improve the quality of care and health outcomes of diabetic patients, with a concentration on particularly vulnerable minority and low-income patients. Initially, the University of Chicago aimed to train health care professionals to deliver state-of-the-art diabetes care. To help disseminate these educational programs beyond a regional level, it initiated national collaborative efforts with the American Diabetes Association and the American Association of Diabetes Educators (2,3,4). For example, the American Association of Diabetes Educators published Diabetes Update: From the Basics Forward, which was a detailed program guide for group facilitators to conduct a 2-day workshop on the clinical and educational management of diabetes (5).

Although these programs directed at health professionals helped improve diabetes care, we recognized the importance of assisting patients to more effectively manage their disease and their lifestyles. Special emphasis has been given to developing programs for minority and vulnerable populations, including African-Americans and Hispanics (6,7,8). Key to this effort has been exploring alternative means of delivering lifestyle modification programs through the use of lay group facilitators and health promoters. For example, the Pathways Lifestyle Modification Program for African-American Women is a successful weight loss program tested in a clinical setting and as part of a church-based lay educator program in inner-city African-American churches (9). In the latest study, 110 African-American women at high risk for diabetes were randomly assigned to either the Pathways program or to a control group. At the end of 14 weeks of active treatment, subjects in the Pathways group lost about 5% of their baseline body weight, whereas weight in control group subjects remained essentially unchanged. Weight loss was maintained for the full year of follow-up (10). The study demonstrated that a culturally relevant lifestyle program can provide significant weight loss in African-American women who typically do not benefit from such efforts. Second, it provided evidence that lay women can be trained to conduct successful lifestyle modification programs in their own neighborhoods (11).

Our most recent efforts use multifactorial interventions that simultaneously aim to improve the system of delivering diabetes care, educate providers and improve their skills in facilitating behavioral change, and empower patients to play a more active role in their care. Currently, we are collaborating with community health centers that serve the indigent population in the Midwest and West Central regions of the country, as well as locally in the city of Chicago. These health centers play a vital role in serving vulnerable populations and have particularly difficult challenges because of limited resources and poor patients (12,13). Many of these efforts are in collaboration with the Health Resources and Services Administration’s Bureau of Primary Health Care and draw on elements of continuous quality improvement (14), chronic care models of disease management (15), and behavioral change methods (16). Other recent health services research work by Chicago D&E core investigators include assessment of risk perception and treatment preferences of patients with diabetes (17), analysis of the care of older patients with diabetes (18,19,20), use of provider profiling and report cards to improve the quality of diabetes care (21,22), cost analyses of diabetes care (23,24,25), and the development of conceptual frameworks for approaching the care of older African-Americans with diabetes and the role of religion in diabetes care (26,27).

Judith Wylie-Rosett, EdD, RD, Professor of Epidemiology and Social Medicine, and Elizabeth A. Walker, DNSc, RN, CDE, Associate Professor of Medicine and Co-Director of Prevention and Control.

The early focus of the Albert Einstein College of Medicine DRTC’s D&E component was on diabetes team development, with an emphasis on dissemination of medical and technological advances to multidisciplinary health care professionals. During the mid-1980s, the scope of this work expanded to address system barriers that prevented delivery of “ideal” diabetes care in various health care settings. The D&E cores supported important clinical research in hypoglycemia, counterregulation, and intensive insulin therapy in type 1 diabetes (28,29,30). The D&E cores also facilitated early research in blood glucose monitoring (31,32), which added to the knowledge base about this emerging technology for self management, including quality assurance. The Albert Einstein College of Medicine D&E team has collaborated in major clinical trials, such as the Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) and the more recent Diabetes Prevention Program (DPP), and contributed to behavioral aspects of the intervention and evaluation as well as the translation efforts for these studies. Thus, the D&E project themes have been at the patient, provider, and system levels, with barrier identification and problem solving for optimal diabetes care and outcomes in communities experiencing health disparities. A major lesson learned over the years has been the wide gulf between awareness and sustained action at each level in health care.

The Neighborhood Family Care Clinic (NFCC) Project (1988–1992) evaluated a program development/expert consultation approach in primary care clinics in medically underserved communities (33,34,35,36). The Dietary Intervention Evaluation of Technology (DIET) (1987–1992) project, which was also supported by the NHLBI, evaluated the use of videos and workbooks to optimize staff time in community-based weight control programs (37,38,39). With the Precede-Proceed Model for Health Promotion Planning as the heuristic, several projects were developed in the early 1990s to test patient-centered interventions to prevent or detect complications of diabetes. A collaborative project with the Centers for Disease Control and Prevention (CDC), Division of Diabetes Translation (1992–1995) evaluated methods for disseminating the CDC care guideline materials in community health centers (40). In the Ophthalmic Complications Prevention Trial (1992–1997), the D&E cores and the National Eye Institute provided support for a randomized clinical trial to compare a multicomponent (telephone, book, and award-winning video) intervention to standard medical care for increasing ophthalmic screening rates among African-Americans with diabetes (41,42,43).

Prevention and risk reduction remain as primary themes for current Albert Einstein College of Medicine D&E research (44,45,46,47,48,49). Models of Demonstration and Evaluation of Weight Loss Study (MODELS) received NHLBI support (1994–1999) and D&E and Biomedical Core support to develop an interactive computer system and the award-winning Complete Weight-Loss Workbook, which was published by the American Diabetes Association (50,51). A randomized controlled clinical trial evaluated the cost and clinical effectiveness of these intervention modalities in making weight control services more accessible in a managed care environment (52,53,54). This research work has extended to the development and evaluation of the WAVE—a quick method to address Weight, Activity, Variety, and Excess in primary care—with D&E core support and to the collaboration among medical schools in the Nutrition Academic Award program (1998–2003) (55). Recent NEI funding (2000–2005) and D&E cores provided support for a randomized controlled clinical trial, Evaluating Alternate Retinopathy Screening Interventions (which was conducted in English and Spanish), to test the hypothesis that tailored telephone intervention increases the rate of dilated retinal examinations compared with standard print intervention. The clinical trial will also evaluate the relative costs and cost-effectiveness of the interventions. Another current collaborative project is Predictors of Medication Adherence: Barriers, Strategies and Perception of Risk. The project combines two areas of research interest: perception of risk for developing diabetes and medication adherence in the DPP. Risk perception survey data are collected in each of the four DPP centers that are also DRTCs. The project goals are to 1) gain insight into associations of risk perceptions to behavioral outcomes (including lifestyle) in the DPP, 2) to assist in the translation of DPP study findings, 3) to inform risk communities, and 4) to increase knowledge of preventive medication behaviors and predictors of adherence. The current D&E research effort builds on insights from earlier studies, such as the competing demands within health care systems and the patient-, provider-, and system-level barriers to achieving optimal diabetes outcomes in high-risk populations. Empirical evidence indicates that behaviorally oriented educational interventions can improve complications screening in a minority population and that technologies, such as telephones and computers, can optimize the use of resources (37,41,42,52,56). Thus, the D&E Cores have extended the sphere of research in the development, implementation, evaluation, and dissemination of study results, as well as collaborations with internal and external investigators who are examining diabetes-related health disparities.

David Marrero, PhD, Professor of Medicine, Director, Prevention and Control Division.

The authorizing legislation for DRTCs specifies that the D&E division 1) engages in research that translates the outcomes of biomedical and behavioral science research into clinical care and 2) develops and evaluates innovative methods and programs for translation activities. The Indiana University (IU)-DRTC has responded to these mandates through the development and interaction of three core units: the Model Diabetes Unit (MDU), the Outreach Core, and the Educational Development and Evaluation Core (EDEC). Operationally, new clinical care and training models are developed and evaluated in MDU clinical settings with support by the EDEC. Validated models are then transferred to, and evaluated in, the community by the Outreach Core, again supported by EDEC.

Historically, the IU-DRTC D&E division focused primarily on determining the essential components of effective education for health care professionals. These efforts resulted in the development and validation of two pedagogical models for training health care professionals. The first focused on the application of multidisciplinary team care, with emphasis on the psychosocial correlates of treatment (57,58,59,60,61,62,63,64,65). The second emphasized altering the professional environment to facilitate the adoption of ideal standards of diabetes care (66,67). We applied these models to training programs that target patient populations that are either difficult to manage or at increased risk of acute and chronic complications of diabetes (e.g., adolescents, gravidas, and low-income minority patients) (68,69,70,71,72,73,74,75,76). Thus, if diabetes treatment is conceptualized as a continuum from primary prevention to tertiary management of end-stage disease, many of our prior activities focused on training health care professionals how to best apply strategies for optimal care of patients with established, complicated diabetes.

The IU-DRTC has also taken an active role in incorporating new technologies into clinical care. We were the first center to investigate the use of computers in analyzing self-obtained blood glucose data (77,78) and the first to conduct randomized control trials of point-of-care laboratory assessment (79,80) and telecommunication technology in diabetes management (81).

Over the past 5 years, the IU-DRTC has shifted its focus to primary and secondary prevention of diabetes and its complications. This focus is driven by two factors: 1) evidence that most patients with diabetes are not receiving optimal care (82,83,84,85,86,87,88,89) and 2) accumulating data suggesting that both type 1 and type 2 diabetes may be preventable and that intensive management of diabetes and new pharmacological interventions will substantially reduce the incidence and progression of complications. The IU-DRTC has developed projects that include 1) training health care professionals at all levels to promote prevention and slow the progression of disease, 2) developing care models for primary and secondary prevention that help practitioners make rational decisions concerning their use of clinical time and resources, and 3) transferring these models to the providers who care for high-risk, medically vulnerable patient populations (e.g., low-income, minority, elderly, and rural patients with diabetes) (90,91,92,93).

Roland G. Hiss, MD, Coordinator, Prevention and Control Division, Michigan DRTC.

The D&E Division of the Michigan DRTC (MDRTC) has pursued multiple themes beginning in 1977. One consistent theme throughout has been community-based diabetes care and translational efforts to improve this care (94,95,96). This involved comprehensive evaluation of 3,000 diabetic patients in 14 Michigan communities, determination of trend lines in diabetes care over 20 years, and development of a system that utilizes the patient as the agent for change in community diabetes care.

Minority health-related research and development programs (97,98,99) began in the late 1980s after Center Director Douglas A. Greene appointed a university-wide panel to advise us on health care issues in African-Americans. The MDRTC’s research focusing on African-Americans with diabetes has yielded new knowledge useful in the development of culturally appropriate interventions targeting this population of patients. The Living With Diabetes: Challenges in the African-American Community patient education program developed by the MDRTC is being distributed nationally by the American Diabetes Association.

Development and validation of measurement and evaluation instruments (100,101,102) began in the early 1980s. The MDRTC has developed valid and reliable measures of diabetes-related knowledge, self-management behavior, attitudes, psychosocial self-efficacy, and psychosocial adaptation. In addition to use in our studies, these measures have been provided to >1,000 investigators worldwide. For the past 15 years, the MDRTC has developed, evaluated, and disseminated a collaborative approach to diabetes care called “patient empowerment” (103,104,105). The empowerment approach has become one of the most widely adopted approaches to diabetes care in the U.S. and is attracting interest in countries as disparate as Mexico, the U.K., Germany, Sweden, Croatia, Australia, and Japan.

The MDRTC has developed and evaluated clinical programs for adolescents, type 1 patients using pump therapy, older adults, and patients with neuropathy (106,107,108,109) and has facilitated clinical research. As an example of the latter, considerable progress has been made defining the phenotype, natural history, genetics, and pathogenesis of maturity-onset diabetes of the young (110,111,112).

The MDRTC has developed professional and patient educational material in several formats (113,114,115). The center has offered professional symposia, undergraduate and graduate teaching for university students, and house officer training programs. Booklets, newsletters, and other educational materials have recently been revised and are available on the website.

Many of the products of the endeavors noted above are available through the MDRTC website (http://www.med.umich.edu/mdrtc/). These include 1) survey instruments (Diabetes Care Profile, Diabetes History, Diabetes Knowledge Test, Diabetes Attitude Scale, Diabetes Empowerment Scale, and the Michigan Neuropathy Screening Instrument) and 2) educational materials (Diabetes Checklist and Facts and Questions patient brochures and 22 information sheets on diabetes topics). Life with Diabetes: A Series of Teaching Outlines, Teenagers with Type 1 Diabetes, and Type 2 Diabetes: A Curriculum for Patients and Health Professionals were selected for publication by the American Diabetes Association.

Edwin Fisher, PhD, Professor of Psychology, Medicine, and Pediatrics.

The D&E Component of the DRTC at Washington University School of Medicine has long emphasized social and contextual influences on behavior in diabetes management as well as fundamental research on clinical diabetes and improvements in clinical diabetes care. Within the DRTC’s MDU, a number of studies have examined enhanced clinical care, such as growth factors in the treatment of end-stage renal failure (116) or cognitive effects of intensive therapy in children with type 1 diabetes (117). Other studies address basic metabolic and endocrine functions, such as studies of leptin (118) or of metabolic factors in brain function (119). The vitality of this activity is reflected in 58 peer-reviewed papers reporting clinical diabetes research from the MDU between December 1999 and November 2000.

Reflecting the DRTC’s emphasis on contextual influences, the MDU has, for over 20 years, supported research on family factors among children and adolescents with type 1 diabetes (120,121,122,123,124). Another area of research has examined the heightened prevalence of depression among those with diabetes (125), proceeding to investigate relations among symptoms of diabetes, depression, and metabolic control (126); more recently, the MDU has examined improved mood and metabolic control after treatment with both cognitive behavior therapy for depression (127) and fluoxetine (128).

Several projects have responded to the disproportionate burden of diabetes among minorities. Initial studies of family factors in pediatric diabetes and other childhood diseases that were developed primarily with white and mostly middle-class families were extended to African-American families with children with type 1 diabetes (129). Prevention of diabetes among African-American women has been the focus of dietary interventions implemented by peer educators (130). A current project extends previous research on organizational factors in improving diabetes patient education (131) to improve diabetes care in federally qualified health centers serving predominantly low-income African-Americans. Another current DRTC project extends the emphasis on peer educators to improve prevention of diabetes among adolescents living in American Indian tribal communities, and a third project examines peer educators in promoting exercise among older adults at risk for diabetes.

An exciting dimension of growth has been the collaboration with three other DRTCs that are also sites in the DPP (University of Chicago, Albert Einstein College of Medicine, and IU). Two collaborative projects address the influence in the DPP of acculturation among its African-American participants and the role of perception of risk. A third project has grown out of previous Washington University research on staff support in the DCCT. In this project, participants in the DCCT intensive treatment group reported that staff reported substantially more nondirective support (cooperative without taking over, accepting feelings and choices) than directive support (directing what recipients do, think, and feel), which is somewhat counterintuitive, given the highly technical, demanding nature of the intensive treatment (132). The four collaborating DRTCs are now measuring support prospectively in the DPP. This will enable comparison of nondirective and directive support and their associations with adherence and quality of life in the DPP’s lifestyle and medication arms.

Over its history, the Vanderbilt University DRTC (VDRTC) has supported translational research in four areas: 1) health disparities in the African-American community, 2) research on adherence and barriers to adherence, 3) clinical intervention and outcomes research, and 4) research on teaching and problem solving for health professionals.

Beginning in the early 1990s, the VDRTC began to address the problem of type 2 diabetes in minorities. Research has ranged from studies of nutrition (133) to community-based interventions (134,135). Successes came about largely because of close collaborative relationships with African-American investigators from Meharry Medical College, Tennessee State University, Fisk University, the county health department, the county hospital, and an outstanding comprehensive health center. Every participating institution has played important roles in our mission to reduce and eventually eliminate Nashville’s unconscionable racial health disparities in diabetes and cardiovascular disease.

Examining the barriers to dietary adherence and ways to help patients overcome these barriers has been a long-standing VDRTC interest. Research in this area has historically been impeded by a lack of systematically developed outcomes measurement tools. The VDRTC’s work attacked the problems several ways, including identifying barriers, developing taxonomies and measures of adherence problems, and mapping barriers to adherence in the community (136,137).

Since the DCCT ended, the challenges of attempting its widespread dissemination became clear: intensified therapy could not be provided in the vast majority of primary care settings (138); the expertise, personnel, and time were neither available in nor affordable for primary care offices; and market forces were working to limit patients’ access to specialty care. One oft-cited alternative was “shared care.” The concept, though intuitively appealing, was not well defined, its costs were not known, and its effects on patients and providers were only imagined. The VDRTC has evaluated two models of shared care. One, the Cumberland Pediatric Diabetes Network, involves general pediatricians (139). The second, the Diabetes Improvement Program (DIP), involves collaboration between Vanderbilt’s diabetes specialists and physicians of general internal medicine (140,141).

Another significant problem in translating the DCCT to practice was (and remains) the lack of readiness of the vast majority of health professionals to promote patient adherence through effective teaching and problem solving. The VDRTC established a track record of expertise in the development, evaluation, and dissemination of training for health professionals. Our Effective Patient Teaching and Problem Solving (EPT) course demonstrated reproducible, positive changes in professionals’ skills (142). The VDRTC also developed and tested a training program called “Sugar Is Not a Poison” for dietitians, who learned to intensify diabetes medical nutrition management in the post-DCCT era (143). Finally, the VDRTC has joined other DRTCs in calling attention to the need for careful educational research in diabetes (144,145).

The VDRTC looks forward to continuing its history of contributing to new projects in the years to come, particularly in the areas of diabetes clinical care and the reduction of diabetes racial health disparities.

The wide array of approaches and the literally hundreds of publications by the DRTCs have expanded our knowledge of how to go from “bench to bedside.” Moreover, the rigorous application of knowledge from such diverse fields as the social sciences, behavioral medicine, education, epidemiology, statistics, economics, organizational theory, medical informatics, and health services research have led to significant advances in our ability to deliver high-quality diabetes care and improve the outcomes of patients. When the DCCT was completed, the DRTCs were asked to develop a strategic plan for its translation; the result, Metabolic Control Matters, became the template for the development of the implementation strategy by the National Institute of Diabetes and Digestive and Kidney Diseases and the CDC (138). Subsequently, these strategies have been incorporated into the National Diabetes Education Program, whose steering committee includes the DRTCs (146).

The future holds many challenges in the care of people with diabetes. The landmark DCCT was followed by the U.K. Prospective Diabetes Study, which demonstrated the efficacy of both glucose and blood pressure control in the reduction of vascular disease in people with diabetes (147,148). Similar data substantiate the beneficial role of lipid control and aspirin therapy in people with diabetes (149,150). We now must translate into clinical practice these and other studies, which, taken together, have shown us the way to dramatically reduce the microvascular, macrovascular, and neurological complications of diabetes. This will require a comprehensive care approach and a shift in the way many patients with diabetes are currently being treated. Finally, translating the results of the DPP presents us with an enormous clinical and public health challenge. Fortunately the 25 years of research by the DRTCs will help point the way.

Contact information for the coordinators for the Prevention and Control Division of each DRTC and their corresponding DRTC grant numbers are listed below:

  • Charles M. Clark, Jr., MD. Grant P60 DK20542.

  • Marshall H. Chin, MD, MPH, Associate Professor of Medicine,Section of General Internal Medicine (B216), University of Chicago,5841 S. Maryland Ave., MC 2007, Chicago, IL 60637. E-mail: mchin@medicine.bsd.uchicago.edu. Grant P60 DK20595.

  • Stephen N. Davis, MD, FRCP, Chief, Division of Diabetes,Endocrinology & Metabolism, Rudolph Kampmeier Professor, Medicine& Molecular Physiology and Biophysics, Director, Nashville VA/JDF Diabetes Research, Address 715 Preston Research Bldg. 2220 Pierce Avenue, Nashville, TN 37232-6303. E-mail: steve.davis@mcmail.vanderbilt.edu. Grant 5P60-AM-20593.

  • Edwin Fisher, PHD, Prof. of Psychology, Medicine & Pediatrics,Division of Health Behavior Research, Washington University, 4444 Forest Park Ave., St. Louis, MO 63108. E-mail: efisher@im.wustl.edu. Grant DK20579-25.

  • Roland G. Hiss, MD, University of Michigan Medical School, Professor & Chair Dept. of Medical Education, G1103 Towsley Center, Box 0201, Ann Arbor, MI 48109-0201. E-mail: redhiss@umich.edu. Grant P60 DK20572".

  • David G. Marrero, PHD, Professor of Medicine, Director, Prevention & Control Division, Diabetes Research & Training Center, Indiana University School of Medicine, Indianapolis, IN 46202. E-mail: dgmarrer@iupui.edu. Grant P60 DK20542

  • Elizabeth A. Walker, DNSC, RN, CDE, Associate Professor of Medicine, Co-Director for Prevention and Control, Diabetes Research & Training Center, 701 Belfer Bldg., Albert Einstein College of Medicine, Bronx, NY 10461. E-mail: walker@aecom.yu.edu. Grant DK20541-23.

  • Judith Wylie-Rosett, EdD, RD, Division of Health, Behavior and Nutrition, Dept. of Epidemiology and Social Medicine, 1308 Belfer Bldg., Albert Einstein College of Medicine, Bronx, NY 10461. E-mail: jwrosett@aecom.yu.edu Grant DK20541-23.

1.
Hiss R: The concept of diabetes translation: addressing barriers to widespread adoption of new science into clinical care (Review).
Diabetes Care
24
:
1293
–1296,
2001
2.
McNabb W, Cook S, Fischer B, Quinn M, Haas L: Dissemination of a continuing education program in diabetes to health care professionals.
Diabetes Educ
20
:
35
–40,
1994
3.
Cook S, Cohen R: Evaluating a workshop for improving diabetes patient education programs: Is it really successful?
Diabetes Educ
12
:
4850
,
1986
4.
American Diabetes Association: Meeting The Standards: A Manual for Completing the American Diabetes Association Application for Recognition. Alexandria, VA, American Diabetes Association, 1988
5.
McNabb W, Miller D: Improving Your Diabetes Patient Education Program: A Workshop for Diabetes Educators, Nurses, and Dietitians. Chicago, IL, American Association of Diabetes Educators, 1990
6.
McNabb W, Quinn M, Tobian J: Diabetes in African-American women: the silent epidemic (Review).
Women’s Health
3
:
275
–300,
1997
7.
Quinn M, McNabb W: Health promotion and disease prevention programs for Chicago Hispanics: a community-based needs assessment.
Illinois Morbid Mortal Rev Quart Rep
4
:
11
–16,
2000
8.
McNabb W, Quinn M, Murphy D, Thorp F, Cook S: Increasing children’s responsibility for diabetes self-care: the In-Control Study.
Diabetes Educ
20
:
121
–124,
1994
9.
McNabb W, Quinn M, Rosing L: Weight loss program for inner-city black women with non-insulin dependent diabetes mellitus: Pathways.
J Am Dietetic Assoc
93
:
75
–77,
1993
10.
McNabb W, Quinn M, Kerver J, Cook S, Karrison T: The PATHWAYS church-based weight loss program for urban African-American women at risk for diabetes.
Diabetes Care
20
:
1518
–1523,
1997
11.
Quinn M, McNabb W: Training lay health educators to conduct a church-based weight loss program for African-American women.
Diabetes Educ
24: 371–378,2001
12.
Chin M, Cook S, Jin L, Drum M, Harrison J, Koppert J, Thiel F, Harrand A, Schaefer C, Takashima H, Chiu S: Barriers to providing diabetes care in community health centers.
Diabetes Care
24
:
268
–274,
2001
13.
Chin M, Auerbach S, Cook S, Harrison J, Koppert J, Jin L, Thiel F, Karrison T, Harrand A, Schaefer C, Takashima H, Egbert N, Chiu S, McNabb W: Quality of diabetes care in community health centers.
Am J Public Health
90
:
431
–434,
2000
14.
Berwick D: Continuous improvement as an ideal in health care.
N Engl J Med
320
:
53
–56,
1989
15.
Wagner E, Austin B, Von Korff M: Organizing care for patients with chronic illness.
Milbank Q
74
:
511
–544,
1996
16.
Rollnick S, Mason P, Butler C: Health Behavior Change: A Guide for Practitioners. Edinburgh, U.K., Churchill Livingstone, 1999
17.
Meltzer D, Egleston B: How patients with diabetes perceive their risk for major complications.
Eff Clin Prac
3
:
7
–15,
2000
18.
Chin M, Zhang J, Merrell K: Specialty differences in the care of older patients with diabetes.
Med Care
38
:
131
–140,
2000
19.
Chin M, Zhang J, Merrell K: Diabetes in the African-American Medicare population: morbidity, quality of care, and resource utilization.
Diabetes Care
21
:
1090
–1095,
1998
20.
Chin M, Su A, Jin L, Nerney M: Variations in the care of elderly persons with diabetes among endocrinologists, general internists, and geriatricians.
J Gerontol Med Sci
55A
:
M601
–M606,
2000
21.
Hofer T, Hayward R, Greenfield S, Wagner E, Kaplan S, Manning W: The unreliability of individual physician “report cards” for assessing the costs and quality of care of a chronic disease.
JAMA
281
:
2098
–2105,
1999
22.
Chin M: Risk-adjusted quality of care ratings for diabetes: ready for prime time? (Review) Diabetes Care
23
:
884
–886,
2000
23.
Meltzer D, Egleston B, Stoffel D, Dasbach E: The effect of future costs on the cost-effectiveness of medical interventions among young adults: the example of intensive therapy for type-1 diabetes.
Med Care
38
:
679
–685,
2000
24.
Hayward R, Manning W, Kaplan S, Wagner E, Greenfield S: Starting insulin therapy in patients with type 2 diabetes: effectiveness, complications, and resource utilization.
JAMA
278
:
1663
–1669,
1997
25.
Gilmer T, O’Connor P, Manning W, Rush W: The cost to health plans of poor glycemic control.
Diabetes Care
20
:
1847
–1853,
1997
26.
Chin M, Polonsky T, Thomas V, Nerney M: Developing a conceptual framework for understanding illness and attitudes in older, urban African Americans with diabetes.
Diabetes Educ
26
:
439
–449,
2000
27.
Quinn M, Cook S, Nash K, Chin M: Addressing religion and spirituality in African Americans with diabetes.
Diabetes Educ
In press
28.
Shamoon H, Mazze R, Pasmentier R, Lucido D, Murphy J: Assessment of longterm glycemia in type 1 diabetes using multiple blood glucose values stored in a memory containing reflectometer.
Am J Med
80
:
1086
–1092,
1986
29.
Mazze R, Shamoon H, Pasmentier R, Lucido D, Murphy J: Reliability of blood glucose monitoring by patients with diabetes mellitus.
Am J Med
77
:
211
–217,
1984
30.
Mazze R, Lucido D, Shamoon H: Psychological and social correlates of glycemic control.
Diabetes Care
7
:
360
–366,
1984
31.
Walker E, Paduano D, Shamoon H: Current practice of quality assurance for blood glucose monitoring in health-care facilities.
Diabetes Care
41
:
1043
–1049,
1991
32.
Walker E: Quality assurance for blood glucose monitoring: the balance of feasibility and standards.
Nursing Clinics North Am
28
:
61
–70,
1993
33.
Wylie-Rosett J, Cypress M, Walker E, Engel S, D’Eramo Melkus G, Di Lorenzo T: Assessment of nutrition care for patients with diabetes in primary care clinics.
J Am Diet Assoc
92
:
584
–586,
1992
34.
Wylie-Rosett J, Basch C, Cypress M: Diabetes quality assurance checklist: assessment of inter-rater and intra-rater reliability.
Diabetes Educ
18
:
411
–415,
1992
35.
Walker E, Wylie-Rosett J, Shamoon H, Engel S, Basch C, Zybert P, Cypress M: Program development to prevent complications of diabetes: assessment of barriers in an urban clinic.
Diabetes Care
18
:
1291
–1293,
1995
36.
Wylie-Rosett J, Basch C, Walker E, Zybert P, Shamoon H, Engel S, Cypress M: Ophthalmic referral rates for patients with diabetes in primary-care clinics located in disadvantaged urban communities.
J Diabetes Complic
9
:
49
–54,
1995
37.
Wylie-Rosett J, Swencionis C, Peters M, Dornelas E, Edlen-Nezin L, Kelly L, Smoller S: A weight reduction intervention that optimizes use of practitioner time, lowers glucose and raises HDL cholesterol levels in older adults.
J Am Diet Assoc
94
:
37
–42,
1994
38.
Dornelas E, Swencionis C, Wylie-Rosett J: The DIET Study: long-term weight outcomes of a cognitive-behavioral weight control intervention in independently living elders.
J Am Diet Assoc
98
:
1276
–1281,
1998
39.
Goldman A, Wylie-Rosett J, Swencionis C, Dornelas E: The effects of dietary changes and intentional weight loss on high-density cholesterol levels in older adults.
J Nutr Elderly
12
:
1
–14,
1992
40.
Walker E, Engel S, Zybert P: Dissemination of diabetes care guidelines: lessons learned from community health centers.
Diabetes Educ
27
:
101
–110,
2001
41.
Basch C, Walker E, Howard C, Shamoon H, Zybert P: A randomized trial to evaluate whether health education increases the rate of ophthalmic examinations among African American with diabetes mellitus.
Am J Public Health
89
:
1878
–1882,
1999
42.
Soet J, Basch C: Using the telephone as a medium for health education (Review).
Health Educ Behav
24
:
759
–772,
1997
43.
Walker E, Basch C, Howard C, Zybert P, Krumholz M, Shamoon H: Incentives and barriers to retinopathy screening among African Americans with diabetes.
J Diabetes Complic
11
:
298
–306,
1997
44.
Walker E: Risk communication in intensive diabetes therapy (Editorial).
Diabetes Spectrum
7
:
76
,
1994
45.
Walker E: Characteristics of the adult learner.
Diabetes Educ
25
:
16
–24,
1999
46.
Walker E, Wylie-Rosett J: Evaluating risk perception of developing diabetes as a multi-dimensional construct (Abstract).
Diabetes
47(Suppl. 1)
:
A5
,
1998
47.
Walker E, Flynn J, Wylie-Rosett J, Mertz C, Kalten M: Perception of risk for developing diabetes among physicians (Abstract).
Diabetes
48(Suppl. 1)
:
A321
,
1999
48.
Graff M, Rubin R, Walker E: How diabetes specialists treat their own diabetes: findings from a study of AADE and ADA membership.
Diabetes Educ
26
:
460
–467,
2000
49.
Walker E: Health behavior: from paradox to paradigm.
Diabetes Spectrum
14
:
6
–8,
2001
50.
Wylie-Rosett J, Swencionis C, Caban A, Friedler A, Schaffer N: The Complete Weight Loss Workbook. Alexandria, VA, American Diabetes Association, 1997
51.
Wylie-Rosett J, Segal-Isaacsion C: Leader’s Guide: The Complete Weight Loss Workbook: Proven Techniques for Controlling Weight-Related Health Problems. Alexandria, VA, American Diabetes Association, 1999
52.
Wylie-Rosett J, Swencionis C, Ginsberg M, Wasserthiel-Smoller S, Caban A, Segal-Isaacson C, Martin T, Lewis J: Computerized weight loss intervention optimizes staff time: the clinical and cost results of a controlled clinical trial in a managed care setting.
J Am Diet Assoc
In press
53.
Kalten M, Ardito D, Cimino C, Wylie-Rosett J: Web-accessible core weight management program.
Diabetes Educ
26
:
929
–936,
2000
54.
Caban A, Cimino C, Swencionis C, Ginsberg M, Wylie-Rosett J: Estimating software development costs for a patient multimedia education project.
J Am Med Informatics Assoc
8
:
185
–188,
2001
55.
Barner C, Wylie-Rosett J, Gans K: WAVE: a pocket guide for a brief nutrition dialogue in primary care.
Diabetes Educ
27: 352–362,
56.
Foster D, Wylie-Rosett J, Walker E: Local survey of optometrists about dilated fundus examinations for patients with diabetes: making use of phone book yellow page listings.
The Diabetes Educ
22
:
605
–608,
1996
57.
Gray D, Langefeld C, Golden M, Orr D: Impact of resident participation in a multidisciplinary diabetes team.
Diabetes Care
16
:
705
–707,
1993
58.
Mazzuca S, Vinicor F, Cohen S, Norton J, Fineberg N, Fineberg S, Duckworth W, Keubler T, Gordon E, Clark C: The Diabetes Education Study: a controlled trial of the effects of intensive instruction for internal medicine residents on the management of diabetes mellitus.
J Gen Int Med
110
:
1
–8,
1988
59.
Mazzuca S, Vinicor F, Einterez R, Tierney W, Norton J, Kalasinski L: Effects of the clinical environment on physicians’ response to postgraduate medical education.
Am Educ Res J
27
:
473
–488,
1990
60.
Ingersoll G, Hibbard R, Kronz K, Fineberg N, Marrero D, Golden M: Pediatric residents’ attitudes about insulin-dependent diabetes mellitus and children with diabetes.
Acad Med
65
:
643
–645,
1990
61.
Golden M, Russell B, Ingersoll G, Gray D, Hummer K: Management of diabetes mellitus in children younger than 5 years of age.
AJDC
139
:
448
–452,
1985
62.
Gray D, Marrero D, Godfrey C, Orr D, Golden M: Chronic poor metabolic control in the pediatric population: a stepwise intervention program.
Diabetes Educ
14
:
516
–520,
1988
63.
Golden M, Herrold A, Orr D: An approach to prevention of recurrent diabetic ketoacidosis in the pediatric population.
J Pediatr
109
:
195
–200,
1985
64.
Golden M, Hibbard R, Ingersoll G, Fineberg N, Marrero D: Pediatric endocrinologic recommendations, pediatric practice, and current pediatric training regarding care of children with diabetes.
Pediatrics
84
:
138
–143,
1989
65.
Kronz K, Hibbard R, Marrero D, Ingersoll G, Fineberg N, Golden M: Management of diabetes in pediatric resident continuity clinics.
Am J Dis Child
143
:
1173
–1176,
1989
66.
Vandagriff J, Stern C, Golden M, Orr D: Using non-traditional methods to teach pediatric residents about IDDM.
Diabetes Educ
15
:
344
–349,
1990
67.
Marrero D, Moore P, Langefeld C, Moorman N, Gergely M, Fineberg SE, Vinicor F, Mazzuca SA, Clark CM: Increasing the use of intensified management of diabetes: an education program for physicians.
J Cont Educ Health Prof
11
:
283
–294,
1991
68.
Ingersoll G, Orr D, Herrold A, Golden M: Cognitive maturity and self-management among adolescents with insulin-dependent diabetes mellitus.
J Pediatr
108
:
620
–623,
1986
69.
Litzelman D, Slemenda C, Langefeld C, Vinicor F: Risk factors for foot lesions in persons with diabetes.
Clin Res
1991
70.
Orr D, Eccles T, Lawlor R, Golden M: Surreptitious insulin administration in adolescents with insulin-dependent diabetes mellitus.
JAMA
256
:
3227
–3230,
1986
71.
Orr D, Golden M, Myers G, Marrero D: Characteristics of adolescents with poorly controlled diabetes referred to a tertiary care center.
Diabetes Care
6
:
70
,
1983
72.
Ingersoll G, Marrero D: A modified quality of life measure for youths: psychometric properties.
Diabetes Educ
17: 1991
73.
Golden M, Ingersoll G, Brack C, Russell B, Wright J, Huberty T: Longitudinal Relationship of asymptomatic hypoglycemia to cognitive function in IDDM.
Diabetes Care
12
:
89
–93,
1989
74.
Orr D, Ingersoll G: Adolescent behavior and development: a biopsychosocial view.
Curr Prob Pediatr
18
:
442
–499,
1989
75.
Ingersoll G, Orr D, Vance M, Golden M: Cognitive Maturity, Stressful Events, and Metabolic Control Among Adolescents With Diabetes: Emotion, Cognition, Health, and Development in Children and Adolescents: A Two-Way Street. 1991
76.
Loghmani E, Rickard K, Washburne L, Vandagriff J, Fineberg N, Golden M: Glycemic response to sucrose-containing mixed meals in diets of children with insulin-dependent diabetes mellitus.
J Peds
119
:
531
–537,
1991
77.
Marrero DG, Kronz KK, Golden MP, Orr DP, Wright JC, Fineberg NS: A clinical evaluation of a computer assisted self-monitoring blood glucose system.
Diabetes Care
12
:
345
–350,
1989
78.
Marrero DG, Mazzuca SA, Golden MP: The impact of computer-generated formats for interpreting SMBG data (Letter).
Diabetes Care
11
:
514
–515,
1988
79.
Marrero D, Vandagriff J, Gibson R, Fineberg S, Fineberg N, Crowley L: Immediate HbA1c results: performance of a new HbA1c system in pediatric outpatient population.
Diabetes Care
15
:
1045
–1050,
1992
80.
Slemenda C, Marrero D, Fineberg S, Moore P, Gibson R: Mail-in paper strip vs. microcolumn technique for measurement of glycosylated hemoglobin.
Diabetes Care
13
:
886
–888,
1990
81.
Marrero D, Vandagriff J, Kronz K, Fineberg N, Golden M, Gray D, Orr D, Wright J, Johnson N: Using telecommunication technology to manage children with diabetes: the Computer-Linked Outpatient Clinic (CLOC) Study.
Diabetes Educ
21
:
313
–319,
1995
82.
Marrero DG: Professional Practice.
In Metabolic Control Matters: Nationwide Translation of the Diabetes Control and Complications Trial: Analyses and Recommendations.
Bethesda, MD, National Institute of Diabetes and Digestive and Kidney Diseases, 1994 (NIH publ. no. 94-3773)
83.
Marrero DG: Current effectiveness of diabetes health care in the U.S.: How far from the ideal?
Diabetes Reviews
2
:
292
–309,
1994
84.
Marrero D, Moore P, Fineberg N, Langefiel C, Clark C: The treatment of patients with insulin-requiring diabetes mellitus by primary care physicians.
J Comm Health
16
:
259
–267,
1991
85.
Marrero D, Moore P, Langefild C, Golichowski A, Clark C: Care of pregnant women with diabetes by primary care physicians: reported strategies for managing pre-gestational and gestational diabetes.
Diabetes Care
15
:
101
–107,
1992
86.
Kraft S, Qiu C, Fineberg N, Clark C Jr, Marrero D: Screening and treatment of diabetic nephropathy by primary care physicians.
J Gen Int Med
14
:
88
–97,
1999
87.
Lazaridis E, Qui C, Kraft S, Marrero D: Same eyes, different doctors: differences in primary care physician referrals for diabetic retinopathy screening.
Diabetes Care
20
:
1073
–1077,
1997
88.
Kraft S, Marrero D, Lazaridis E, Qiu C, Fineberg N, Clark C: Primary care physicians’ practice patterns and diabetic retinopathy: current levels of care.
Arch Fam Med
6
:
29
–37,
1997
89.
Marrero DG: Evaluating the quality of care provided by primary care physicians to people with non-insulin dependent diabetes mellitus.
Diabetes Spectrum
9
:
30
–34,
1996
90.
Marrero D, Kraft S, Fineberg N: Improving primary care physicians detection of diabetes complications (Abstract).
Diabetes
44(Suppl. 1)
:
A47
,
1995
91.
Kirkman M, Ross S, Lazaridis E, Marrero D: A strategy for improving adherence to diabetes care guidelines by rural physicians (Abstract).
Diabetes
47(Suppl. 1)
:
A183
,
1995
92.
Marrero D, Kirkman M, Williams S, Hoen H: The Clinton County Outreach Project (CCOP): impact on diabetes care by rural physicians (Abstract).
Diabetes
49 (Suppl. 1): A221, 2000
93.
Kraft S, Honebein P, Prince M, Marrero D: The SOCRATES curriculum: an innovative integration of technology and theory in medical education.
J Audiov Media Med
20
:
166
–171,
1997
94.
Hiss R, Bowbeer M, Hess G, Stepien C, Armbruster B (Eds.): Diabetes in Communities II. Ann Arbor, MI, University of Michigan, 1992
95.
Hiss R, Anderson R, Hess G, Stepien C, Davis W: Community diabetes care: a 10-year perspective.
Diabetes Care
17
:
1124
–1134,
1994
96.
Hiss R, Gillard M, Armbruster B, McClure L: Comprehensive evaluation of community-based diabetic patients: effect of feedback to the patients and their physicians: a randomized controlled trial.
Diabetes Care
24
:
690
–694,
2001
97.
Fitzgerald J, Gruppen L, Anderson R, Funnell M, Jacober S, Grunberger G, Aman L: The influence of treatment modality and ethnicity on attitudes in type 2 diabetes.
Diabetes Care
23
:
313
–318,
2000
98.
Anderson R, Funnell M, Arnold M, Barr P, Edwards G, Fitzgerald J: Assessing the cultural relevance of an education program for urban African Americans with diabetes.
Diabetes Educ
26
:
280
–289,
2000
99.
Anderson R, Barr P, Edwards G, Funnell M, Fitzgerald J, Wisdom K: Using focus groups to identify psychosocial issues of urban black individuals with diabetes.
Diabetes Educ
22
:
28
–33,
1996
100.
Anderson R, Funnell M, Fitzgerald J, Marrero D: The Diabetes Empowerment Scale: a measure of psychosocial self-efficacy.
Diabetes Care
23
:
739
–743,
2000
101.
Anderson R, Fitzgerald J, Funnell M, Gruppen L: The third version of the Diabetes Attitude Scale.
Diabetes Care
21
:
1403
–1407,
1998
102.
Fitzgerald J, Davis W, Connell C, Hess G, Funnell M, Hiss R: Development and validation of the Diabetes Care Profile.
Eval Health Prof
19
:
209
–230,
1996
103.
Funnell M, Anderson R, Arnold M, Barr P, Donnelly M, Johnson P, Taylor-Moon D, White N: Empowerment: an idea whose time has come in diabetes education.
Diabetes Educ
17
:
37
–41,
1991
104.
Anderson R: Patient empowerment and the traditional medical model: A case of irreconcilable differences? (Commentary) Diabetes Care
18
:
412
–415,
1995
105.
Anderson R, Funnell M, Butler P, Arnold M, Fitzgerald J, Feste C: Patient empowerment: results of a randomized controlled trial.
Diabetes Care
18
:
943
–949,
1995
106.
Floyd J, Cornell R, Jacober S, Griffith L, Funnell M, Wolf L, Wolf F: A prospective study identifying risk factors for discontinuance of insulin pump therapy.
Diabetes Care
16
:
1470
–1478,
1993
107.
Funnell M, Arnold M, Fogler J, Merritt J, Anderson L: Participation in a diabetes education and care program: experience from the diabetes care for older adults project.
Diabetes Educ
24
:
163
–167,
1998
108.
Funnell M, Herman W: Diabetes care policies and practices in Michigan nursing homes,
1991
. Diabetes Care
18
:
862
–866,
1995
109.
Feldman E, Stevens M, Thomas P, Brown M, Canal N, Greene D: A practical two-step quantitative clinical and electrophysiological assessment for the diagnosis and staging of diabetic neuropathy.
Diabetes Care
17
:
1281
–1289,
1994
110.
Herman W, Fajans S, Ortiz F, Smith M, Sturis J, Bell G, Polonsky K, Halter J: Abnormal insulin secretion, not insulin resistance, is the genetic or primary defect of MODY in the RW pedigree.
Diabetes
43
:
40
–46,
1994
111.
Herman W, Fajans S, Smith M, Polonsky K, Bell G, Halter J: Diminished insulin and glucagon secretory responses to arginine in nondiabetic subjects with a mutation in the hepatocyte nuclear factor-4α/MODY1 gene.
Diabetes
46
:
1749
–1754,
1997
112.
Fajans S, Bell G: Maturity-Onset Diabetes of the Young: A Model for Genetic Studies of Diabetes Mellitus. In Diabetes Mellitus: A Fundamental and Clinical Text. 2nd ed. LeRoith D, Taylor SF, Olefsky JM, Eds. Philadelphia, JP Lippincott, 2000
113.
Anderson R, Donnelly M, Gorenflo D, Funnell M, Sheets K: Influencing the attitudes of medical students towards diabetes: results of a controlled study.
Diabetes Care
16
:
503
–505,
1993
114.
Funnell M, Anderson R, Oh M: Adapting a diabetes patient education program for use as a university course.
Diabetes Educ
20
:
297
–302,
1994
115.
Anderson R, Fitzgerald J, Funnell M, Barr P, Stepien C, Hiss R, Armbruster B: Evaluation of an activated patient diabetes education newsletter.
Diabetes Educ
20
:
29
–34,
1994
116.
Vijayan A, Franklin S, Behrend T, Hammerman M, Miller S: Insulin-like growth factor I improves renal function in patients with end-stage chronic renal failure.
Am J Physiol
276
:
R929
–R934,
1999
117.
Hershey T, Bhargava N, Sadler M, White N, Craft S: Conventional versus intensive diabetes therapy in children with type 1 diabetes: effects on memory and motor speed.
Diabetes Care
22: 1999
118.
Liu J, Askari H, Dagogo-Jack S: Basal and stimulated plasma leptin in diabetic subjects.
Obes Res
7
:
537
–544,
1999
119.
Craft S, Asthana S, Newcomer J, Wilkinson C, Matos I, Baker L, Cherrier M, Lofgreen C, Latendresse S, Petrova A, Plymate S, Raskind M, Grimwood K, Veith R: Enhancement of memory in Alzhemier’s disease with insulin and somatostatin but not glucose.
Arch Gen Psychiatry
56
:
1135
–1140,
1999
120.
Anderson B, Miller J, Auslander W, Santiago J: Family characteristics of diabetic adolescents: relationship to metabolic control.
Diabetes Care
4
:
586
–591,
1981
121.
Auslander W, Haire-Joshu D, Rogge M, Santiago J: Predictors of diabetes knowledge in newly diagnosed children and parents.
J Pediatr Psychol
16
:
213
–228,
1991
122.
Delamater A, Bubb J, Davis S, Smith J, Schimdt L, White N, Santiago J: Randomized prospective study of self-management training with newly diagnosed diabetic children.
Diabetic Care
13
:
492
–498,
1990
123.
LaGreca A, Auslander W, Greco P, Spetter D, Fisher Jr E, Santiago J: I get by with a little help from my family and friends: adolescents’ support for diabetes care.
J Pediatr Psychol
20
:
449
–476,
1995
124.
Wysocki T, Harris M, Greco P, Bubb J, Danda C, Harvey L, McDonnell K, Taylor A, White N: Randomized, controlled trial of behavior therapy for families of adolescents with insulin dependent diabetes mellitus.
J Pediatr Psychol
25
:
23
–33,
2000
125.
Lustman P, Griffith L, Clouse R: Depression in adults with diabetes: results of 5-yr follow-up study.
Diabetes Care
11
:
605
–612,
1988
126.
Lustman P, Griffith L, Clouse R, Cryer P: Psychiatric illness in diabetes mellitus: relationship to symptoms in blood glucose control.
J Nerv Ment Dis
174
:
736
–742,
1986
127.
Lustman P, Griffith L, Freddland K, Kissel S, Clouse R: Cognitive behavior therapy for depression in type 2 diabetes mellitus: a randomized controlled trial.
Ann Int Med
129
:
613
–621,
1998
128.
Lustman P, Freedland K, Griffith L, Clouse R: Fluoxetine for depression in diabetes: a randomized double-blind placebo-contrlled trial.
Diabetes Care
23
:
618
–623,
2000
129.
Auslander W, Thompson S, Dreitzer D, White N, Santiago J: Disparity in glycemic control and adherence between African-American and Caucasian youths with diabetes: family and community contexts.
Diabetes Care
10
:
1569
–1575,
1997
130.
Auslander W, Haire-Joshu D, Williams J, Houston C, Krebill H: The short-term impact of a health promotion program for African-American women.
Res Social Work Pract
10
:
56
–77,
2000
131.
Heins J, Nord W, Cameron M: Establishing and sustaining state-of-the-art diabetes patient education programs: research and recommendations.
Diabetes Educ
18
:
501
–508,
1992
132.
Davis K, Heins J, Fisher E Jr: Types of social support deemed important by participants in the DCCT (Abstract).
Diabetes
46(Suppl. 1)
:
89A
,
1997
133.
Hargreaves MK, Schlundt DG, Buchowski MS, Hardy RE, Rossi SR, Rossi JS: Stages of change and the intake of dietary fat in African American women: Improving stage assignment using a new eating style questionnaire.
J Am Diet Assoc
99
:
1392
–1399,
1999
134.
Schlundt DG, Mushi C, Larson CO, Marrs M: Use of innovative technologies in the evaluation of Nashville’s REACH 2010 community action plan: reducing disparities in cardiovascular disease and diabetes in the African American community.
J Ambulatory Care Manage
24
:
51
–60,
2001
135.
Ma’at-Shambhala I, Presley-Cantrell L, Sterling T, Imara H, Montanez F, Tuller C, Jones C, Troutman A, Elisa-McLaren K, Liang S, Grigg-Saito D, Fouad M, Shapiro L, Pichert J: REACH 2010: a unique opportunity to create strategies to eliminate health disparities among women of color.
Am J Health Studies
In press
136.
Schlundt D, Pichert J, Rea M, Puryear W, Penha-Walton M, Kline S: Situational obstacles to dietary adherence for adolescents with diabetes.
Diabetes Educ
20
:
207
–211,
1994
137.
Schlundt D, Stetson B, Plant D: Situation taxonomy and behavioral diagnosis using prospective self-monitoring data: application to dietary adherence in patients with type 1 diabetes.
J Psychopathology Behav Assess
21
:
19
–36,
1999
138.
Fisher E, Heins J, Hiss R, Lorenz R, Marrero D, McNabb W, Wylie-Rosett J: Metabolic Control Matters: Nationwide Translation of the Diabetes Control and Complications Trial. Bethesda, MD, National Institute of Diabetes and Digestive and Kidney Diseases, 1994 (NIH publ. no. 94-3773)
139.
Lorenz R, Boswell E, Gregory B: Integration of primary and specialty services for children with type 1 diabetes.
Cumberland Pediatric Diabetes Network
Submitted for publication
140.
Quinn D, Elasy T, Graber A, Brown A, Wolff K, Ye H: Overcoming the turf battles: developing a pragmatic collaborative model to improve diabetes care.
Jt Comm J Qual Improv
27
:
255
–264,
2001
141.
Brown A, Wolff K, Graber A, Elasy T: The role of advanced practice nurses in a shared care diabetes practice model.
Diabetes Educ
In press
142.
Boswell E, Pichert J, Lorenz R, Schlundt D, Penha M: Dissemination of a teaching skills course through hospital-based staff developers.
Patient Educ Couns
27
:
247
–256,
1996
143.
Lorenz R, Gregory R, Davis D, Schlundt D, Wermager J: Diabetes training for dietitians: needs assessment, program description, and effects on knowledge and problem solving.
J Am Diet Assoc
100
:
225
–228,
2000
144.
Elasy T, Ellis S, Brown A, Pichert J: A taxonomy of diabetes educational interventions.
Patient Educ Couns
43
:
121
–127,
2001
145.
Wheeler M, Wylie-Rosett J, Pichert J: Diabetes education research (Editorial).
Diabetes Care
24
:
421
–422,
2001
146.
Clark CM: The National Diabetes Education Program: changing the way diabetes is treated.
Ann Int Med
130
:
324
–326,
1999
147.
UK Prospective Diabetes Study Group: Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. [see comments] BMJ 
317
:
703
–713,
1998
148.
United Kingdom Prospective Diabetes Study Group: Effect of intensive blood-glucose control with sulfonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33).
BMJ
352
:
837
–853,
1998
149.
Pyorala K, Pedersen TR, Kjekshus J, Faergeman O, Olsson AG, Thorgeirsson G, the Scandinavian simvastatin Survivial Study (4S) Group: Cholesterol lowering with simvastatin improves prognosis of diabetic patients with coronary heart disease: a subgroup analysis of the Scandinavian Simvastatin Survival Study (4S).
Diabetes Care
20
:
614
–620,
1997
150.
Colwell JA: Aspirin therapy in diabetes mellitus (Letter).
Diabetologia
40
:
867
,
1997

Address correspondence and reprint requests to Charles M. Clark, Jr., MD, Professor of Medicine and Pharmacology, Indiana University School of Medicine, Director, Diabetes Research & Training Center, Regenstrief Health Center–Fifth Floor, 1001 W. Tenth St., Indianapolis, IN 46202-2859. E-mail: clark_c@regenstrief.iupui.edu.

Abbreviations: CDC, Centers for Disease Control and Prevention; DCCT, Diabetes Control and Complications Trial; D&E, Demonstration and Education; DPP, Diabetes Prevention Program; DRTC, Diabetes Research and Training Center; EDEC, Educational Development and Evaluation Core; IU, Indiana University; MDRTC, Michigan DRTC; MDU, Model Diabetes Unit; VDRTC, Vanderbilt University DRTC.