Current Funding Priorities in Health Behavior and Health Behavior

Change at NIDDKJune 20, 2014

Christine Hunter, Ph.D., ABPPDirector of Behavioral Research

National Institute of Diabetes & Digestive & Kidney Diseaseshunterchristine@niddk.nih.gov

Chronic

Common

Consequential

Costly

To support and conduct research to combat diabetes and other endocrine and metabolic diseases, liver and other digestive diseases, nutritional disorders, obesity, and kidney, urologic and hematologic diseases.

NIDDK’s MISSION

Obesity Type 2 Diabetes

• Approx. 2/3 of U.S. adults overweight or obese

• Approx. 1/3 of U.S. adults obese

• High rates in the young

• Annual cost: $147B

• Approx. 25.8 million U.S. cases (8.3% of population)

• Projected to ~50 million by 2050

• Increasing in the young

Scope, Consequences, and Cost

Chronic Kidney Disease• Approx. 23 million

U.S. cases of CKD• Major causes:

diabetes, hypertension

• ESRD annual cost: $27B

• Annual cost: $245B

↑ 41% since 2007

Health Behavior Research Priorities

Strategic Plans

http://www.obesityresearch.nih.gov/about/strategic-plan.aspx http://www.niddk.nih.gov/about-niddk/strategic-plans-reports/Pages/advances-emerging-opportunities-in-diabetes-research.aspx

Health Behavior Research Priorities: Diabetes

• Lifestyle change to prevent diabetes (e.g., DPP, LookAHEAD ) • Dissemination and implementation research• Evaluating efficient and sustainable models of delivery• Engaging high risk populations• Maintaining changes over time• Tension between tailored and generalizable

• Healthcare team/system research• Screening for diabetes and effectively communicating risk• Screening and follow-up related to gestational diabetes• More rapid medication intensification

Health Behavior Research Priorities: Diabetes

• Adherence to a complicated and unremitting regimen with serious long and short-term consequences for non adherence• Frequent daily blood glucose monitoring, adjusting insulin

dosages, additional medications, attention to all food intake and physical activity, managing co-morbidities…

• Effectively using existing diabetes technologies: blood glucose monitors, CGM, pump, pen, etc

• Support/skill needs vary across the lifespan and type of diabetes• Young children, adolescents, young adults, and the elderly• Involving the patient, their family, and support networks?

Eat Less and Exercise More

So simple in principle…yet so complicated in practice

8

Health Behavior Research Priorities: Obesity

A Few of the Challenges A healthy lifestyle requires vigilance over time

Initiation behavior change is challenging but understanding how to sustain change is a key challenge

Ubiquitous presence of highly palatable (rewarding) foods

Increased activity/reduced sedentary lifestyle is not the default and there are many barriers to exercise

Need to better identify the drivers of decision making and action in food and activity choices?

Understanding Individual Variability

A permissive food environment and sedentary lifestyle contribute to obesity

Within similar environments there is considerable individual variability in weight and weight gain trajectory

Improved understanding of behavioral phenotypes is needed to advance obesity prevention and treatment

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N=374(42.2%)

N=152(17.1%)

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Four-Year Weight Loss Trajectories of 887 ILI Participants Who Had Lost ≥ 10%

Initial Weight at Year 1

Basic Behavioral Science/Behavioral Phenotyping

Greater understanding about why people behave as they do in regard to intake, physical activity, and sedentary behavior Mechanisms, processes, and patterns of behavior and

social functioning that can partially explain individual differences in weight

Need to understand: Strength of influence Variation across populations How these factors interact with each other, biological

influences/genes, and the environment

NIDDK Research Behavioral Priorities

• Continued emphasis:– High risk populations/ reducing health disparities– More potent and durable interventions– Potential scalability and sustainability in to “real world”

context and practice

• New emphasis—the “ends” of the translational continuum:– Basic behavioral science and bench to bedside translation – Evaluation of natural experiments– Pragmatic research

Evaluation of Natural Experiments in Obesity

• PAR 12-257: Time Sensitive Obesity Policy and Program Evaluation (R01) NIDDK, NCI, NICHD, NIA, and OBSSR Accelerated review/award process (4 months from receipt)

PA 13-110: Obesity Policy Evaluation Research (R01) NIDDK, NCI, NICHD, NHLBI, NIA, and OBSSR

PA 13-100: School Nutrition and Physical Activity Policies, Obesogenic Behaviors and Weight Outcomes (R01) NICHD, NCI, NHLBI, and OBSSR

PA 13-098: (R21), NICHD, NCI, NHLBI, and OBSSR PA 13-099: (R03), NICHD, NCI, and OBSSR

Evaluation of Natural Experiments in Diabetes

• (R18) PAR-13-365• Escalating rates of diabetes and healthcare costs• A time of dynamic change for healthcare in the U.S. • Often, limited evidence about how well they work

• Support rigorous evaluation of “natural experiments” to prevent or treat diabetes in healthcare settings– Identify what works for whom in clinical practice with diverse

populations, and/or patients with multiple co-morbidities– Provide data to more rapidly inform clinicians, healthcare

systems, employer/purchasers, and policy makers

Pragmatic Research in Healthcare Settings to Improve Diabetes Prevention and Care

• (R18) PAR-13-366 and (R34) PAR-13-367

• Research that maximizes the applicability and relevance of the trial’s results to routine care/community conditions– Test novel, practical, and cost efficient healthcare based

strategies to improve health outcomes

• Key Considerations for Funding:

– Integrated into existing healthcare settings– Leveraging existing resources within these practices

Other Health Behavior Relevant NIDDK Issued or Partnered Funding Opportunities

Translational Research to Improve Diabetes and Obesity Outcomes (R01) PA-13-352

Addressing Health Disparities in NIDDK Diseases (R01) PA-13-183

Home and Family Based Approaches for the Prevention or Management of Overweight or Obesity in Early Childhood (R01) PA-13-153

Home and Family Based Approaches for the Prevention or Management of Overweight or Obesity in Early Childhood (R21) PA-13-154

Diabetes Impact Award-Closed Loop Technologies: Clinical, Physiological and Behavioral Approaches to Improve Type 1 Diabetes Outcomes (DP3)

RFA-DK-14-014

Other Health Behavior Relevant NIDDK Issued or Partnered Funding Opportunities

Chronic Illness Self-Management in Children and Adolescents (R01) PA-14-029

Health Promotion Among Racial and Ethnic Minority Males (R01) PA-13-328

Behavioral and Social Science Research on Understanding and Reducing Health Disparities (R01) PA-13-292

Dissemination and Implementation Research in Health (R01) PAR-13-055

Behavioral Interventions to Address Multiple Chronic Health Conditions in Primary Care (R01) PA-14-114

Understanding and Promoting Health Literacy (R01) PAR-13-130

Some Final Thoughts… Don’t feel locked into finding the perfect FOA

If you don’t find a perfect match, use the “parent” FOAs Innovative investigator initiated research is highly valued and

funded Innovation is important but significance and approach often drive

the score Be very clear about why your research fills an important gap

and why the answers will matter? Contact a program officer early in the process!

Questions?

1994 2000 2010

<14% 14-17.9% 18-21.9% 22-25.9% ≥ 26%

<4.5% 4.5-5.9% 6.0-7.4% 7.5-8.9% ≥ 9.0%

Obesity

Diabetes (diagnosed)

Percentage of U.S. Adults who are Obese and Diabetic