1. 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 hunterchristine@niddk.nih.gov

2. 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

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

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 N=174 (19.6% ) Percentage Weight Loss 1234 Year 0-5% 5- 6.9% 7- 10% ≥ 10% Gained N=374 (42.2 %) N=15 2 (17.1 %) N=99 (11.2% ) N=88 (9.9%) +2 0 2 4 6 8 10 12 14 16 18 +4 Four-Year Weight Loss Trajectories of 887 ILI Participants Who Had Lost ≥ 10% Initial Weight at Year 1

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 PAR-13-366PAR-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: – I ntegrated into existing healthcare settings – Leveraging existing resources within these practices

16. 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

17. 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

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!

21. Questions?

23. 19942000 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