When it comes to preventing and managing diabetes (and the obesity that often goes along with it), most of the hard work is in the patient's hands.

"Very little of what happens in managing these conditions happens in the clinical office. Most of it happens out there in the patients' day-to-day lives," says Gareth Dutton, PhD, an associate professor of preventive medicine at the University of Alabama at Birmingham and APA's representative to the National Diabetes Education Program (NDEP). "APA has such an important role to play at the table. We have expertise in helping individuals navigate the challenges of behavior change."

That's why APA has joined forces with NDEP, a federally funded program sponsored by the National Institutes of Health and the Centers for Disease Control and Prevention. The program, established in 1997, includes more than 200 partners working together to provide prevention and treatment resources and materials to diabetes patients and health-care providers.

Researchers have a long way to go in deciphering where best to help patients (in schools, libraries, other community settings?) and who can best deliver the programs (community health workers, lay professionals, peer support networks?). But two things are clear to Dutton and his colleagues at NDEP: "One, the patient and his or her family have to be at the center of the team," he says. "Ninety-nine percent of the work must be done by the patient."

Two, he says, experts are increasingly realizing the importance of patient-centered outcomes. Physicians may fret over a patient's blood pressure or blood-glucose level. "But it's things like quality of life, emotional well-being, social relationships, that patients care about on a day-to-day basis," he says. "If we can help patients see improvement in those outcomes, we may see better outcomes overall."

Driving down rates of diabetes will undoubtedly be difficult, but things are moving in the right direction, says Dutton. "There's a long way to go and multiple pieces that have to fall into place, but we're starting to get a better recognition of what we have to do and how to do it."

—Kirsten Weir