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Current Funding Priorities in Health Behavior and Health Behavior Change at NIDDK June 20, 2014

Current Funding Priorities in Health Behavior and Health Behavior Change at NIDDK June 20, 2014. Christine Hunter, Ph.D., ABPP Director of Behavioral Research National Institute of Diabetes & Digestive & Kidney Diseases hunterchristine@niddk.nih.gov. NIDDK’s MISSION.

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Current Funding Priorities in Health Behavior and Health Behavior Change at NIDDK June 20, 2014

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  1. Current Funding Priorities in Health Behavior and Health Behavior Change at NIDDKJune 20, 2014 Christine Hunter, Ph.D., ABPPDirector of Behavioral ResearchNational Institute of Diabetes & Digestive & Kidney Diseaseshunterchristine@niddk.nih.gov

  2. NIDDK’s MISSION 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. Chronic Common Consequential Costly

  3. Scope, Consequences, and Cost Type 2 Diabetes Chronic Kidney Disease Obesity • 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 • Approx. 23 million U.S. cases of CKD • Major causes: diabetes, hypertension • ESRD annual cost: $27B • Annual cost: $245B • ↑ 41% since 2007

  4. Health Behavior Research Priorities

  5. 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

  6. 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

  7. 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?

  8. Health Behavior Research Priorities: Obesity Eat Less and Exercise More So simple in principle… yet so complicated in practice 8

  9. 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?

  10. 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 +4 N=88 (9.9%) +2 Gained Four-Year Weight Loss Trajectories of 887 ILI Participants Who Had Lost ≥ 10% Initial Weight at Year 1 0 0-5% N=174 (19.6%) 2 4 N=99 (11.2%) 6 5-6.9% Percentage Weight Loss 8 7-10% N=152 (17.1%) 10 12 ≥ 10% 14 N=374 (42.2%) 16 18 1 2 3 4 Year

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. Other Health Behavior Relevant NIDDK Issued or Partnered Funding Opportunities

  17. Other Health Behavior Relevant NIDDK Issued or Partnered Funding Opportunities

  18. 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!

  19. Questions?

  20. Percentage of U.S. Adults who are Obese and Diabetic 1994 2000 2010 Obesity <14% <4.5% 14-17.9% 4.5-5.9% Diabetes (diagnosed) 18-21.9% 6.0-7.4% 22-25.9% 7.5-8.9% ≥ 26% ≥ 9.0%

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