For many years, the burgeoning cases of diabetes have been at alarming – some would even use the phrase “pandemic” – levels. When the COVID-19 pandemic swept the planet, new solutions to combat diabetes were sorely needed. Endocrine News sits down with Christopher Holliday, PhD, MPH, FACHE, who is heading up the CDC’s Division of Diabetes Translation, to discuss the complex relationship between these conditions, the move to raise awareness of the pre-diabetes threat, and many more initiatives to combat this overwhelming scourge.
In the past three years, the COVID-19 pandemic has disrupted just about everything. Ask anyone around, and they’ll have a story about how the virus impacted them or their loved ones. But the pandemic shone a light on some fissures in the healthcare community, gaps that have required some rethinking and innovation in how to approach patients who become sick from COVID-19, especially those patients living with one or more chronic disease.
The pandemic also exposed the fact that chronic disease and infectious disease are more closely related than previously recognized. Research has shown time and again that people with diabetes are at higher risk for hospitalization, needing ventilation, and even death, should they become sick from the novel coronavirus. In 2016, the Centers for Disease Control and Prevention, the American Medical Association, and the Ad Council partnered to launch the national Do I Have Prediabetes? public service campaign that takes a look at prediabetes and how to reverse it. This year, a national communications effort to raise awareness of the campaign highlighted the serious complications from COVID-19 people with diabetes can face.
Christopher Holliday, PhD, MPH, MA, FACHE, is the director of the Division of Diabetes Translation (DDT) in the CDC’s National Center for Chronic Disease Prevention and Health Promotion. He is one of the experts leading teams that spearhead the Do I Have Prediabetes? campaign and conduct applied research and surveillance studies to better understand the impacts of COVID-19 on people with diabetes.
Holliday joined the CDC in 2021 and has been working for more than a decade to prevent type 2 diabetes, reduce health disparities, and improve the health of all people with diabetes. Endocrine News caught up with Holliday to talk about the wake-up call that is prediabetes, reducing the impacts of social determinants of health, and the complicated — and at times confounding – relationship between diabetes and COVID-19.
Endocrine News: First, tell us a little about yourself.
Christopher Holliday: I have always had an affinity toward health and healing, since I was young. I have been working in public health leadership and management roles for over 25 years, as well as in clinical and private/non-profit settings at the national, state, and local levels. I have been leading teams, shaping research, and developing programming to prevent and manage chronic disease and improve health outcomes. My approach is to link data, resources, and relationships to create new solutions that shape policies, systems, and environments that support and promote health, equity, and well-being.
“In some cases, COVID-19 infection might directly increase diabetes risk. Or it might have an indirect impact, such as steroid treatments during hospitalizations that could lead to transient hyperglycemia or pandemic-associated increases in body mass index. More research can help us better understand the link between COVID-19 and diabetes risk.”
Christopher Holliday, PhD, MPH, MA, FACHE, director, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention
I am trained as a community psychologist and research scientist with over a decade of experience in community-based participatory research and empowerment methodologies, addressing the social and structural determinants of health.
Endocrine News: What attracted you to medicine and public health? After that, what called you to diabetes prevention?
Christopher Holliday: I come to this work personally and professionally, as I have had many close relatives with diabetes and its complications like diabetic retinopathy, stroke, and heart attack. My grandfather was on dialysis for 15 years after chronic kidney failure. Supporting him through this complex journey, as a young person, was transformative and fueled my work to help prevent this for others and to help those with diabetes manage it well. Over the course of my career, my primary areas of research included diabetes and cardiovascular health, community engagement, coalition-building and collective impact strategies to prevent chronic disease, and health disparities among disproportionately affected populations and communities.
Diabetes can reduce quality of life and its complications can be devastating; yet, in many cases, type 2 diabetes, the most common form of diabetes, is preventable. Healthcare providers are often the first line in screening patients at high risk for type 2 diabetes and getting them to critical help they need to prevent or delay progression from prediabetes to type 2 diabetes.
Christopher Holliday, PhD, MPH, MA, FACHE, director, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention
With 37 million U.S. adults with diabetes and another 96 million with prediabetes, my vision is a world free of the devastation of diabetes. I’m humbled and grateful to lead these efforts with my colleagues at the CDC, working toward a future in which a transformation in the health and well-being of these communities is assured.
Endocrine News: One of DDT’s main missions is to advance health equity for everyone with diabetes. What are some things that can be done in the clinic and at a policy level to eliminate health disparities for all Americans who are living with diabetes or who are at risk of type 2 diabetes?
Christopher Holliday: I’m so glad you asked that. Health disparities present a major obstacle to preventing and managing diabetes in the U.S. Many factors, including lower income or lack of access to healthcare, make it difficult for people to get and stay as healthy as possible.
We follow the science to carry out our work. We measure how diabetes affects populations; study interventions that work best in communities; translate those findings into strategies; and then help partners put those strategies into action in their communities. Some specific examples of key efforts include increasing access to services, like the National Diabetes Prevention Program (National DPP) and Diabetes Self-Management Education and Support (DSMES), that help people prevent and manage diabetes.
EN: What are some of the strides that DDT has made in reducing health disparities in diabetes? What are some upcoming initiatives you’re excited about?
CH: I’m excited about our new strategic plan because it embeds health equity in all our work. And one of our top goals is to reduce the impact of the social determinants of health, like poor access to services and unhealthy food environments, that contribute to the onset of diabetes. We’re taking the steps I just described to accomplish that.
One example of work that is already underway is our partnership with community health workers. Community health workers are trusted members of their communities, and they understand the very real challenges their communities experience. With CDC support, states are implementing and evaluating strategies to manage diabetes and prevent type 2 diabetes in communities that are medically underserved. Many states are training community health workers in Diabetes Self-Management Education and Support and helping them become coaches for the National Diabetes Prevention Program, thereby increasing access to these services in culturally and linguistically appropriate ways. And that’s just two examples of how this work directly affects diabetes management and prevention in communities.
We encourage healthcare providers to refer at-risk patients to the National DPP. This is a CDC-recognized lifestyle change program that has been proven by research to cut the risk of type 2 diabetes by more than half, and it can improve patients’ overall health.
Christopher Holliday, PhD, MPH, MA, FACHE, director, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention
I also want to quickly mention our work with the Native Diabetes Wellness Program. American Indian and Alaska Native people are more likely to have type 2 diabetes than any other racial or ethnic group in the U.S. This program promotes diabetes prevention and overall health, while honoring a balance of cultural practices and Western science.
EN: Tell me a little about the impetus of the Do I Have Prediabetes? campaign.
CH: Prediabetes serves as a wake-up call. Many people will be surprised to learn that more than one in three American adults, that’s 96 million people, have prediabetes and 81% of them don’t even know they have it. Prediabetes is a health condition that puts people at high risk for other serious conditions like heart attack, stroke, and type 2 diabetes.
But the good news is that for most people, type 2 diabetes can be prevented or delayed. We knew we needed to spread that message far and wide, so we launched the Do I Have Prediabetes? campaign to help people learn their risk for prediabetes and type 2 diabetes. Through the campaign, we encourage people to go to DoIHavePrediabetes.org and take a one-minute risk test to know where they stand and be able to take action.
EN: Media engagement has been robust since the campaign’s launch. Can you share a little about the results you’ve seen so far?
CH: Raising awareness of prediabetes has been a major focus since the campaign launched in 2016. So far, the campaign has resulted in more than 11 million prediabetes risk tests completed. And, depending on their results, people are then encouraged to talk to their doctor and enroll in a National Diabetes Prevention Program, if appropriate. Additionally, the website offers tips for making simple lifestyle changes that can help people manage weight, eat healthier, and get active. So, the simple act of taking a 1-minute test can lead people to take actions to prevent or delay type 2 diabetes.
EN: The marketing collateral and advertising pieces are fresh and engaging. How important was it to partner with the Ad Council and the AMA to spread the message and awareness of prediabetes?
CH: Our partnership with both the Ad Council and the American Medical Association has been invaluable in raising awareness of prediabetes. The first step in preventing type 2 diabetes is learning your risk, and our partners have played a major role in helping us spread the message and getting people to take action – specifically, more than 11 million risk tests have been completed as the first step.
With 37 million U.S. adults with diabetes and another 96 million with prediabetes, my vision is a world free of the devastation of diabetes. I’m humbled and grateful to lead these efforts with my colleagues at the CDC, working toward a future in which a transformation in the health and well-being of these communities is assured.
Christopher Holliday, PhD, MPH, MA, FACHE, director, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention
The latest campaign includes public service announcements under the theme “Change the Outcome,” which are designed to reach Americans ages 40-65 who may be at risk for prediabetes. The campaign seeks to emphasize that prediabetes may be prevented or delayed through changes like eating a little differently or getting more physical activity.
EN: Having diabetes certainly puts patients at higher risk for worse COVID-19 outcomes, but studies are starting to suggest that COVID-19 infection can trigger diabetes. Is that something you’re seeing as well? Does that again speak to the need to prevent diabetes?
CH: Chronic diseases and infectious diseases are often thought of as separate lanes in public health, but the COVID-19 pandemic has highlighted how intimately related those two lanes really are. For example, a study published in the Morbidity and Mortality Weekly Report shows that people under the age of 18 with COVID-19 were more likely to be newly diagnosed with diabetes in the months after infection than those without COVID-19. In some cases, COVID-19 infection might directly increase diabetes risk. Or it might have an indirect impact, such as steroid treatments during hospitalizations that could lead to transient hyperglycemia or pandemic-associated increases in body mass index. More research can help us better understand the link between COVID-19 and diabetes risk.
We also know that the COVID-19 pandemic influenced people’s health in at least a few ways that could affect someone’s risk for prediabetes or type 2 diabetes, including more sedentary lifestyles, disruptions in regular medical care, and restricted food choices. And, as you mentioned, people with diabetes are three times more likely to experience severe illness when testing positive for COVID-19. It will still be years before we understand the full impact of the pandemic on our nation and our health, but it’s clear that COVID-19 has underscored how critically important it is to prevent chronic diseases like type 2 diabetes whenever possible.
EN: Can you share a little about the CDC’s applied research and surveillance studies in diabetes? Have there been any surprising or eureka moments?
CH: These efforts are at the core of everything we do. Mitigating risk factors is a critical factor in preventing type 2 diabetes, and our applied research efforts help us to not only identify risk factors but determine what types of interventions are most effective. There have been major findings over the past few years, and some of the most compelling include data on diabetes among young people.
“It will still be years before we understand the full impact of the pandemic on our nation and our health, but it’s clear that COVID-19 has underscored how critically important it is to prevent chronic diseases like type 2 diabetes whenever possible.”
Christopher Holliday, PhD, MPH, MA, FACHE, director, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention
For example, findings from the 20-year SEARCH for Diabetes in Youth study showed that cases of type 1 and type 2 diabetes are surging in people under age 20. The number of young people living with type 2 diabetes almost doubled from 2001 to 2017. These numbers are troubling, particularly because young people are more likely to have diabetes complications at an earlier age than those diagnosed as adults.
EN: What’s the main thing Endocrine Society members and others who treat diabetes should know about the CDC’s work in this area?
Diabetes can reduce quality of life and its complications can be devastating; yet, in many cases, type 2 diabetes, the most common form of diabetes, is preventable. Healthcare providers are often the first line in screening patients at high risk for type 2 diabetes and getting them to critical help they need to prevent or delay progression from prediabetes to type 2 diabetes. We encourage healthcare providers to refer at-risk patients to the National DPP. This is a CDC-recognized lifestyle change program that has been proven by research to cut the risk of type 2 diabetes by more than half, and it can improve patients’ overall health.
We also want all healthcare providers to be aware of Diabetes Self-Management Education and Support and refer patients to these services. It’s unrealistic to expect people with diabetes to make lifestyle changes without support, and we know that DSMES improves health outcomes. Still, less than 7% of patients participate within the first year of diagnosis. Providers are vital in linking their patients to DSMES to help them sustain behaviors needed to self-manage their diabetes. We urge healthcare professionals to learn how they can refer their patients to the National DPP and DSMES.
To learn more about DSMES and DPP, go to: https://www.cdc.gov/diabetes/professional-info/health-care-providers.html
Bagley is the senior editor of Endocrine News, who wrote about the Endocrine Society’s new telehealth consensus statement in the November issue.
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