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The NEXT-D2 Study (Natural Experiments for Translation in Diabetes)

Shaping the Science and Decisions for U.S. Health Policies to Prevent Diabetes and its Complications

Approximately 29 million Americans have diabetes and another 86 million have prediabetes and are at risk for progression to diabetes. Developing effective strategies at the federal, state and local levels to prevent and manage diabetes is a national priority. Public agencies and private organizations are continually implementing different programs to address these challenges, including innovations related to the 2010 passage of the Affordable Care Act (ACA). For example, such programs include the recent Medicaid expansion, decisions about whether counseling for obesity management can be reimbursed, innovative care management interventions targeting “high-risk” patients, etc. These programs can be considered “natural experiments.” In other words, they are rolled out in real-world settings without the control of research investigators. Many of these natural experiments are not supported by any evidence. Others are based on prior efforts that were studied and found to be successful, but have since been modified or are now being applied to new populations and in different settings that may lead to different results. For example, effective innovations from the employer insurance market to improve diabetes control may not necessarily be as helpful when implemented for a Medicaid population.

The Natural Experiments for Translation in Diabetes (NEXT-D2) network includes 8 academic institutions and 3 funding agencies. The co-leads for this collaboration are Dr. Carol M. Mangione from UCLA and Dr. Lizheng Shi from Tulane University.



  • Centers for Disease Control and Prevention (CDC)
  • National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), within the National Institutes of Health (NIH)
  • Patient-Centered Outcomes Research Institute (PCORI)

The goal of NEXT-D2 is to use the collective input of the network to provide rigorous evaluations of natural experiments that guide the evolution of policies and programs to improve diabetes care and prevention.