Did the prevention strategy work?

1. xxxxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxxxxxxxxxxx How to Evaluate Did the prevention strategy work? Detectives in the Classroom – Investigation 5-2: How to Evaluate Investigation 5-2

2. Hypotheses 1 How is this disease distributed? 2 Is there an association? 3 Is the association causal? 4 What should be done to prevent the disease? Where are we and where are we going? What’s my hypothesis? Did the exposure and the disease turn up together? Why did the exposure and the disease turn up together? What should I do? What should society do? 5 Did the prevention strategy work? Was is worth the effort? Should we continue it? Investigation 5-2 Detectives in the Classroom – Investigation 5-2: How to Evaluate

3. DZ E DZ Random Assignment Healthy People DZ E - DZ ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Time Review Trial Detectives in the Classroom – Investigation 5-2: How to Evaluate Investigation 5-2

4. DZ E DZ Healthy People DZ E - DZ ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Time Review Cohort Study Detectives in the Classroom – Investigation 5-2: How to Evaluate Investigation 5-2

5. E DZ E E - DZ E ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Time Review Case-Control Study Detectives in the Classroom – Investigation 5-2: How to Evaluate Investigation 5-2

6. E E DZ - DZ Review Cross- Sectional Study ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Time Detectives in the Classroom – Investigation 5-2: How to Evaluate Investigation 5-2

7. Review Epi Talk Risk Management Steps taken to reduce the levels of risk to which an individual or a population is exposed. Detectives in the Classroom – Investigation 5-2: How to Evaluate Investigation 5-2

8. “Diet and Exercise Dramatically Delay Type 2 Diabetes” Detectives in the Classroom – Investigation 5-2: How to Evaluate Investigation 5-2

9. 1 2 3 “Diet and Exercise Dramatically Delay Type 2 Diabetes” Group Intervention Description % Developed Diabetes Lifestyle Intervention Participants received intensive training in diet, exercise, and behavior modification skills aimed at reducing weight by 7% through a low-fat diet and exercising for 150 minutes a week. 14% Metformin & Information Participants received treatment with the drug metformin (850 mg twice a day) and received information on diet and exercise. 22% Placebo & Information Participants received placebo pills, in place of metformin, and received information on diet and exercise. 29% Detectives in the Classroom – Investigation 5-2: How to Evaluate Investigation 5-2

10. Epi Teams Detectives in the Classroom – Investigation 5-2: How to Evaluate Investigation 5-2

11. “Diet and Exercise Dramatically Delay Type 2 Diabetes” Detectives in the Classroom – Investigation 5-2: How to Evaluate Investigation 5-2

12. E DZ DZ Trial Cohort Study Case-Control Study DZ E E E DZ DZ Random Assignment Healthy People Healthy People E DZ DZ E E E - - - - DZ E Cross- Sectional Study E DZ DZ DZ DZ ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Time Time Time Time 1 “Diet and Exercise Dramatically Delay Type 2 Diabetes” Detectives in the Classroom – Investigation 5-2: How to Evaluate Investigation 5-2

13. Epi Talk Epi Talk Random Assignment Assignment of individuals to groups by chance. Random assignment should make the groups similar at the start of the study. Random assignment should not be confused with haphazard assignment. Detectives in the Classroom – Investigation 5-2: How to Evaluate Investigation 5-2

14. Epi Talk Epi Talk Placebo An inactive medication or procedure. In a trial, placebos are given to the control group. Because a placebo is an inactive medication or procedure, it means “no exposure.” Detectives in the Classroom – Investigation 5-2: How to Evaluate Investigation 5-2

15. 2 “Diet and Exercise Dramatically Delay Type 2 Diabetes” Detectives in the Classroom – Investigation 5-2: How to Evaluate Investigation 5-2

16. 3 1 14% Lifestyle Intervention DZ 22% 2 Metformin & Information DZ - 3 29% Placebo & Information DZ Trial 3,234 people at high risk for type 2 diabetes Random Assignment Time Detectives in the Classroom – Investigation 5-2: How to Evaluate Investigation 5-2

17. 4 “Diet and Exercise Dramatically Delay Type 2 Diabetes” Type 2 diabetes “… is strongly associated with obesity (more than 80% of people with type 2 diabetes are overweight), inactivity, family history of diabetes, and racial or ethnic background.” Detectives in the Classroom – Investigation 5-2: How to Evaluate Investigation 5-2

18. “Diet and Exercise Dramatically Delay Type 2 Diabetes” No Type 2 Diabetes Type 2 Diabetes Risks Type 2 Diabetes Relative Risk Total 40 40 % 40 60 Obesity 100 100 4 times as likely a b c d No Obesity 10 10 90 100 10 % 100 Count Divide Compare Detectives in the Classroom – Investigation 5-2: How to Evaluate Investigation 5-2

19. An independent group of experts that periodically reviews and evaluates study data. It is interested in safety of participants, study conduct and progress, and preliminary findings. It can make recommendations about continuation, modification, or termination of the study. Epi Talk Epi Talk External Data Monitoring Board Detectives in the Classroom – Investigation 5-2: How to Evaluate Investigation 5-2

20. 5 “Diet and Exercise Dramatically Delay Type 2 Diabetes” External Data Monitoring Board Detectives in the Classroom – Investigation 5-2: How to Evaluate Investigation 5-2

21. E DZ DZ Trial Cohort Study Case-Control Study DZ E E E DZ DZ Random Assignment Healthy People Healthy People E DZ DZ E E E - - - - DZ E Cross- Sectional Study E DZ DZ DZ DZ ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Time Time Time Time Ideal Conditions? / Everyday Conditions? Detectives in the Classroom – Investigation 5-2: How to Evaluate Investigation 5-2

22. DZ E DZ Healthy People DZ E - DZ ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Time 6 Lifestyle Intervention Effectiveness Cohort Study Detectives in the Classroom – Investigation 5-2: How to Evaluate Investigation 5-2

23. Type 2 Diabetes Lifestyle Intervention DZ Type 2 Diabetes - No Lifestyle Intervention DZ Effectiveness: Cohort Study People at high risk for type 2 diabetes Time Detectives in the Classroom – Investigation 5-2: How to Evaluate Investigation 5-2

24. E DZ E E - DZ E ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Time 7 Lifestyle Intervention Effectiveness Case-Control Study Detectives in the Classroom – Investigation 5-2: How to Evaluate Investigation 5-2

25. Lifestyle Intervention No Lifestyle Intervention Lifestyle Intervention - No Lifestyle Intervention Effectiveness: Case-Control Study People with type 2 diabetes People without type 2 diabetes but at high risk Time Detectives in the Classroom – Investigation 5-2: How to Evaluate Investigation 5-2

26. E E DZ - DZ 8 Lifestyle Intervention Effectiveness Cross- Sectional Study ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Time Detectives in the Classroom – Investigation 5-2: How to Evaluate Investigation 5-2

27. Lifestyle Intervention No Lifestyle Intervention Type 2 Diabetes - No Type 2 Diabetes Effectiveness: Cross-Sectional Study Cross- Sectional Study Time Detectives in the Classroom – Investigation 5-2: How to Evaluate Investigation 5-2

28. Time DZ E DZ DZ E DZ - Essential Question 5 Did the prevention strategy work? Detectives in the Classroom – Investigation 5-2: How to Evaluate Investigation 5-2

29. Investigation 5-2 has ended. CDC How to Evaluate Detectives in the Classroom – Investigation 5-2: How to Evaluate Investigation 5-2