American College of Cardiology

“Make The Link! Diabetes, Heart Disease and Stroke" is a multi-year initiative of the American Diabetes Association (ADA) and the American College of Cardiology (ACC) that started in 2001 It is aimed at increasing awareness of the link between diabetes and cardiovascular disease (CVD).

With more than 60% experiencing hypertension and over 90% having lipid disorders, people with diabetes are two to four times more likely to suffer a heart attack or stroke than people without diabetes—and two out of three people with diabetes will die from cardiovascular disease. The problem will only become larger. More than 17 million people have diabetes and the caseload is growing by nearly a million new cases annually. In addition, 16 million people are at risk for the disease as they are in the pre-diabetes phase. As the diabetes population becomes more sedentary and obese, diabetic CVD is becoming even more of a paramount health issue.

In addition to the American College of Cardiology, additional professional partnerships have been established with the American College of Physicians, American Academy of Family Physicians, Preventive Cardiovascular Nurses Association, National Council on Patient Information and Education and many others. Make The Link! is led by a volunteer Advisory Board consisting of leading endocrinologists and cardiologists with strong interest in the relationship between diabetes and cardiovascular disease. ACC members involved in this effort include Noel Bairey Merz, Jim Galloway, Robert Rosenson and Robert Frye.

Plans for 2004

Plans for 2004 include the following:

First quarter:

• Completion of patient education toolkits
• Radio news tour including Dr. Galloway as ACC spokesperson
• Writers Briefing including Dr. Bairy-Merz as ACC spokesperson

Second quarter:

• Posting patient education toolkits on ACC and ADA websites
• Webcast educational programs held and promoted to ACC members and others

Fourth Quarter:

• Research/Clinical Conference: Inflammation, Diabetes and Cardiovascular Disease (September 30-October 2, 2004, Chicago)
• A continued comprehensive push to garner media attention on the link between diabetes and heart disease to include special emphasis during November (Diabetes month) and February (Heart month)
• Expanded use of consumer public service announcements to target transit systems.
• New consumer advertising campaign to launch in November 2004.

Future

With the growing demand for tools, materials and programs related to cardiovascular disease and diabetes, plans are underway to extend the program beyond 2004. Make The Link! is thus expected to be an ongoing, annual core initiative of the ADA. The continuation of Make The Link! represents a unique approach to programming. Industry partners actively participate in the development and implementation of all aspects of the initiative.

The remainder of this document summarizes what has been accomplished to date and describes in detail the plans for 2004 and beyond.

Make The Link! efforts target both consumers and health care professionals (specifically, primary care physicians who are high prescribers of diabetes agents, endocrinologists/diabetes specialists, cardiologists, nurse practitioners/physician assistants and diabetes educators). The Make The Link! initiative also targets intermediary channels for promotion and dissemination of key messages and materials. Examples of intermediaries include existing partners, such as the National Diabetes Education Program, third-party organizations representing consumer, health and allied health professionals, as well as media outlets and managed care organizations.

Make The Link! seeks to reduce the morbidity and mortality associated with diabetes and cardiovascular disease. Following are the long-term goals of the initiative:

• People with diabetes and their families “make the link” between diabetes and CVD events (e.g., myocardial infarction, stroke and peripheral vascular disease).
• People with diabetes know their risk for CVD and know what they can do about it.
• More people with diabetes diagnosed with CVD risk factors are taking action.
• Health care professionals have the information and tools they need to evaluate for and effectively treat the constellation of CVD-related problems for primary and secondary prevention in people with diabetes.
• Health care professionals disseminate information about the association between diabetes and CVD, and their patients understand that there is a constellation of problems that tend to appear together (e.g., obesity, hypertension, hyperglycemia, dyslipidemia).
• Health care professionals understand that the presence of diabetes alters the goals and protocols for treating cardiovascular disease and its risk factors.

"Make The Link!" stresses that diabetes management is more than control of just blood glucose. People with diabetes must also manage blood pressure and cholesterol and talk to their health provider to learn about other ways to reduce their chance for heart attacks and stroke. The key program messages for professionals and patients are summarized below.

Key messages for health professionals:

• People with diabetes are at high risk for having a heart attack, stroke, and/or heart failure. Two out of three people with diabetes die from heart disease or stroke. Talk to your patients about the ABCs of Diabetes and their increased risk for CVD.
• To prevent complications, a comprehensive approach to the management of diabetes, to include aggressive control of blood glucose and other CVD risk factors, is required.

Key messages for patients:

• There’s more to diabetes than management of just blood glucose. It’s important to manage blood glucose, blood pressure and cholesterol. Know the ABCs of diabetes.
• More treatments are available than ever before. Talk to your health care provider and learn what you can do to reduce your risk for heart disease.
• Take steps to lower your risk:
  • Reduce A1C to less than 7 percent
  • Lower blood pressure to less than 130/80
  • Aim for the following blood lipid numbers:
    • LDL cholesterol less than 100 mg/dl
    • HDL above 40 mg/dl
    • Triglycerides below 150 mg/dl
  • If you smoke, get help to quit
  • Ask your health care provider about taking aspirin

Diabetes and Cardiovascular Disease Review Newsletter: This quarterly newsletter was launched last year and is distributed to more than 65,000 health care providers. The newsletter features a main cover article, abstracts of pertinent studies and a reproducible patient page. Each issue features two advertisements from Make The Link! Sponsors. It is provided at no charge to the target audience which includes ACC members.

Direct Mail to Health Professionals: A direct mail promotion was launched during June 2003. The mail piece promotes ADA clinical goals and encourages health professionals to talk to their patients about the link between diabetes and heart disease. Health professionals can receive free patient education materials by calling 1-800-DIABETES. The free materials will include a brochure holder to display in medical offices and copies of a new brochure featuring questions for patients to ask their health care team about the link between diabetes and heart disease.

Other Make The Link! Support Materials: Other materials have been produced and distributed and include an “ABC” notepad in which health providers can record a patient’s ABC goals and action steps and a pocket guide of ADA’s clinical practice recommendations.

Diabetes-Cardiovascular Disease Toolkit: In March 2004, Make-the-Link launched the Diabetes-Cardiovascular Disease Toolkit, a new resource comprised of 26 reproducible patient education tools produced in partnership with the ACC and Preventive Cardiovascular Nurses Association (PCNA). This toolkit is available on CDRom, hard copy (a box of 26 file folders and masters for photocopying) and online (www.diabetes.org/MakeTheLink and acc.org/Outreach/diabetes/diabetes.htm). The toolkit is available free to health care professionals through 1-800-DIABETES, and was promoted in March/April issues of The Diabetes Educator, ACP’s The Observer, AAFP’s American Family Physician, as well as ADA, ACC and PCNA publications. In April 2004, a promotional postcard was mailed to 65,000 health care professionals on the Make the Link! mailing list. Information regarding the availability of the toolkit will continue to be disseminated through such vehicles as Cardiology, ACC Weekly, CCA Update and Cardiosource.

Outlined below are the major patient education tools developed to promote Make The Link! messages:

• The Diabetes Channel #23, Make The Link!: A new addition to ADA’s patient education series, The Diabetes Channel, focus on diabetes and CVD and is written at the 5th-grade reading level. Available in English and Spanish.
• “Questions to Ask Your Health Care Provider” Brochure: This piece, produced in English and Spanish, encourages patients to talk to their doctor about their increased risk for diabetes and CVD.
• Development of feature article series on managing medications with the National Council on Patient Information and Education (NCPIE)
• 4-part series on the ABCs of Diabetes published in Diabetes Forecast and CVS pharmacy magazine.
• The Diabetes Advisor: This series of patient information is written at the 7th grade reading level features 2 related topics: 1. Make The Link! Diabetes, Heart Disease, and Stroke: Learning About Your Risk and What You Can Do; and 2. Make The Link! Finding and Treating Heart Disease and Stroke in People with Diabetes.

A comprehensive public awareness campaign focusing on the link between diabetes and heart disease has been a key strategy of the initiative and the tactics used are summarized below

Dear Abby: A letter on the ABCs of Diabetes published in February 2003 resulted in the largest one-day spike of calls to ADA’s National Call Center.

Public Service Campaign: A comprehensive Make The Link! public service advertising (PSA) campaign launched during National Diabetes Month (November) 2002 and included television, radio and print ads. The ads urge people with diabetes to learn about the ABCs of diabetes and talk to their health care professional about their increased risk for CVD. To date, nearly 400 television stations have aired the spot approximately 37,000 times (31,000 airings in English; 6,000 airings in Spanish). Approximately, 350 radio stations have aired the pre-recorded radio ad more than 48,000 times (44,200 English airings; 4,100 Spanish airings).

Times Square Astrovision: In New York City’s Times Square, the 30-second television spot was aired on the NBC Astrovision screen hourly each day from November 5, 2002 through January 15, 2003 and again in November 2003. In addition, Accent Health, the CNN affiliate relaying programming to physician waiting rooms, The Wellness Channel, and the TV Guide Channel have the television PSA in circulation. Ladies Home Journal and Prevention Magazine have featured the print PSA. United Airlines featured the 30 second TV ad on all flights with on-board entertainment during November 2003.

Media Efforts: The media efforts continue to pay off. Dr. John Buse, Chair of the ADA’s Make The Link! Advisory Committee, has conducted interviews with the following long-lead publications: Woman's Day, Heart & Soul, More Magazine, Reader’s Digest, Ebony, Medical Herald, Prevention Magazine and Drug Topics. Numerous more interviews have been held with newspapers and radio outlets in response to related research studies. Editions of the New York Times Magazine, Newsweek, and Ebony have featured diabetes advertorial sections that include spreads on the link between diabetes and heart disease.

Satellite Media Tour: During November 2002, a satellite media tour featuring Dr. Buse and Dr. Robert Rosenson, Fellow of the American College of Cardiology was conducted. Thirteen interviews with local TV stations were conducted to announce the launch of the PSA and to educate viewers about the “ABCs” of diabetes (estimated audience: 500,000). Also in November 2002, audio news releases in English and Spanish on diabetic CVD were distributed to radio stations in November (estimated audience: 30 million on 575 radio stations).

2003 Heart Month (February): Another audio news release featuring interviews with ACC leaders was released to nationwide radio stations.

2004 Heart Month: During February 2004, Make the Link! took advantage of the spotlight on heart health to promote Make the Link messages:

• A national press release was issued by both organizations urging people with diabetes to talk to their health care provider about their increased risk for heart disease and stroke.
• On February 10, Dr. James Galloway hosted a radio media tour on diabetic cardiovascular disease. Interviews were held in nine key markets including Detroit, MI, Portland, OR, Chicago, IL, Boston ,MA, and Rochester, NH, and a national feed was distributed to an additional 300 radio stations.

Writers’ Briefing, March 23, 2004: Along with the National Diabetes Education Program and the ACC, a writers briefing was hosted for consumer magazines on March 23 in New York City. The briefing featured presentations on the link between diabetes and CVD (Nathaniel Clark, MD), the ABCs of Diabetes (Jim Gavin, MD, PhD), coronary heart disease in women with diabetes (Noel Bairey Merz, MD, FACC) and peripheral arterial disease in diabetes (Peter Sheehan, MD). The interest in the briefing was high, with participation from 21 magazines including Newsweek, Business Week, Women’s Day, Redbook, Ebony, Essence, Shape en Espanol, Hoy!, and Bloomberg.

Billboards and Airport Advertising: In follow-up to a mailing that was done to request free advertising space in nationwide airports and billboards, approximately 1,000 Make the Link! billboards were produced and distributed in 35 states and 180 airport dioramas.

Total audience reach: 58 million

The ACC and the ADA are in a unique position to provide information about diabetes and CVD to both the health care community and consumers. The growing interest in diabetic CVD and the increasing numbers of Americans with either diabetes or pre-diabetes, have led to a heightened interest in this topic by health organizations, medical specialties and the health care industry.

While the management of blood sugar has always been and remains a cornerstone of diabetes care, diabetes requires a comprehensive program of management that includes management of blood glucose, blood pressure, cholesterol and other CVD risk factors.

By increasing the awareness of effective risk reduction strategies and providing tools that increase the patient-physician dialogue, Make The Link! seeks to increase awareness and learning that will help people with diabetes reduce their chances for having a heart attack or stroke.