Ending an Epidemic

Ronald Ackermann uses community-based research to curb America’s diabetes crisis

By Roger AndersonSeptember 19, 2018

In the time it takes to read this paragraph, another American will be diagnosed with one of the nation’s most burdensome diseases. Every 15 to 20 seconds — or 5,200 times a day — an adult joins 30 million others living with diabetes. The numbers are staggering: nearly 10 percent of the population has the disease and 1 in 4 adults is living with blood sugar levels that physicians consider prediabetic.

“There’s a growing realization that we can’t deliver care effectively to this huge population if we continue to deliver the same care we have for the past two decades,” says Ronald Ackermann, director of Northwestern’s Institute for Public Health and Medicine (IPHAM) and an internist with Northwestern Medical Group. “Health systems must look further upstream to consider and address some of the social determinants and other root causes that place individuals and groups at higher risk for specific conditions. As cases continue to rise, the motivation to find these ‘upstream’ solutions is greater now than it’s ever been.”

Ackermann’s research on systems-level approaches to chronic disease prevention and care began more than two decades ago. In the time since, he has earned a master of public health degree, moved to Chicago to become a physician-scientist at Northwestern, and established himself as a national thought leader in the field.

“I recall being labeled as ambitious or even unrealistic when I was a young faculty member at Indiana University for suggesting that we could conduct research on, discover, and deploy a nationwide solution to diabetes,” says Ackermann, a professor of general internal medicine and geriatrics, medical social sciences, and endocrinology, who joined Northwestern in 2011.

Throughout his career, Ackermann has focused on ways to improve health and healthcare by integrating primary care with health promotion and disease prevention programs. In particular, he’s a national expert in natural experiments — observational studies allowing for the seemingly random assignment of study subjects — to improve the prevention and control of diabetes and other chronic conditions.

In April, Medicare announced it would cover an effective and affordable diabetes intervention that was first validated by Ackermann and his colleagues.

As IPHAM director, Ackermann helps to coordinate and connect the institute’s 300-plus members while maintaining the nexus for public health activities at the Feinberg School of Medicine. The institute’s 14 centers focus on a range of patient populations — from communities to the individual — and issues — from health behaviors to genetic determinants of disease. Between 2012 and 2017, IPHAM members published more than 15,000 articles, which have been cited more 227,000 times. In 2017, the institute’s centers received nearly 600 research awards totaling $130 million.

“It’s been an important watershed to see the medical school launch IPHAM and further expand research beyond patients, providers, and care systems, to also focus on broader populations,” says Ackermann, who is also Feinberg’s senior associate dean for public health as well as director of IPHAM’s Center for Community Health. “To do that effectively, we have to be engaging with and collaborating with communities and the public health sector.”

For Ackermann, that has meant meeting at-risk patient populations within their own communities and working with colleagues to design research protocols that can be rigorously validated.

The Diabetes Prevention Program (DPP) has changed the way people approach type 2 diabetes prevention worldwide. In 2002, a clinical trial funded by the National Institutes of Health showed that providing ongoing, intensive coaching and support for prediabetic adults attempting to make lifestyle changes and lose just 10 to 20 pounds can cut their risk of developing diabetes by 58 percent.

That’s when Ackermann’s team went to work. In 2003, Ackermann began coordinating a group of researchers that was seeking to utilize existing community and healthcare networks to help this program reach millions of Americans with prediabetes. A decade later, the Centers for Disease Control and Prevention was granted $80 million to lead a wide-scale rollout known as the National DPP. In parallel, an $11.8 million demonstration project launched in 2011 showed that the approach also works to improve health and delay diabetes among Medicare recipients at high risk for diabetes. Today, the program is being offered face to face by more than 1,700 local organizations, as well as “virtually” through electronic (including mobile) platforms. Medicare and many other health payers cover the costs so that eligible adults need not pay to access the program.

“Whether it’s diabetes, heart disease, or cancer, solutions that affect large populations require both community partnerships and rigorous research methods,” says Ackermann. “Public health researchers need to be willing to embed themselves within a community to learn what it’s like to live the lives they are attempting to change. It’s not enough for us to rely only on data when it’s the people who matter most.”  

Moving between Northwestern’s downtown campus and several Chicago communities, Ackermann remains dedicated to his research, his patients, and the training of the next generation of physician-scientists.

“My goal isn’t to build a lengthy CV or to win awards,” says Ackermann. “I’d be very content to finish my career with half as many scientific publications, if that’s what it takes to spend a bit of extra time with community groups and stakeholders to fully understand their needs and to ensure my research is useful for them. I think that’s how I can make the most meaningful impact on population health and inspire others to do the same.”