clinical/translational, and innovation projects. Approximately a quarter of the budget supported career development awards, followed by training grants and targeted research. of type 1 diabetes. However, promising Type 1 Diabetes TrialNet and the Immune findings in research with animal models Tolerance Network, provide important have often failed to translate to human cases resources for the diabetes community to of diabetes (14). Large-scale federally sup- examine new approaches and therapies. Ad- ported clinical research initiatives, including ditional research defining the underlying Portfolio distribution of basic and clinical research at the ADA in 2011 (proportions of 2011 allocations in dollars). The proportion of clinical and translational research supported by the Association has increased over the last 5 years and now makes up approximately a third of the overall portfolio. The majority of the portfolio is dedicated to basic research. pathways and identifying potential treat-ment strategies, coupled with active inte-gration with these resources, is essential for progress. Once effective prevention strate-gies are identified, it will be critical to facil-itate widespread clinical translation to advance prevention efforts. Complications Although the etiologies differ, both type 1 and type 2 diabetes can result in many of the same acute and chronic complica-tions. Cardiovascular disease accounts for the majority of mortality in patients with type 2 diabetes. Recent large trials, orig-inally presented at the ADA Scientific Sessions in 2008, have failed to demon-strate that intensive glycemic control strategies can necessarily reduce this burden (15–17). Although control of other cardiovascular risk factors contin-ues to be a mainstay of prevention, a greater understanding of the link between disordered glycemic control and the de-velopment of cardiovascular disease re-mains an important research objective. Research is also needed to address chronic microvascular complications of neuropathy, nephropathy, retinopathy, as well as hypoglycemia and severe hy-perglycemic states, which also represent a significant proportion of the morbidity and costs of diabetes. The identification of populations of patients with diabetes that are particularly resistant or highly sus-ceptible to the development of these complications may provide important clues to the genetic and metabolic pre-cursors. Systems biology approaches ex-amining genetic and metabolic profiles, and the interfaces between pathways, may provide a more global understanding of the commonalities and distinct effects of hyperglycemia on various organ systems. Once the physiological pathways involved in these processes are identified, they must be carefully dissected to elucidate new targets for the development of therapeutic agents. The ADA has and will continue to work in collaboration with other organi-zations, including industry partners, JDRF, the National Kidney Foundation, and others, to address critical complica-tions research needs. Through support of specific grant opportunities and collabo-rative projects, the ADA will continue to provide support for research in these areas. Planned work group and consensus reports on hypoglycemia and chronic kidney dis-ease emphasize the importance that the ADA places on understanding the complexity 1384 DIABETES CARE, VOLUME 35, JUNE 2012 care.diabetesjournals.org of the molecular and cellular processes underlying these complications, and the output from such activities will provide further guidance for future investigations in these areas. Diabetes care in subpopulations Comparing the effects of therapies or treatment strategies in diverse and repre-sentative patient populations can identify particular benefits or specific risks in various stages of disease, in demographic subgroups (e.g., ethnicity, age, sex), and in the context of particular comorbid con-ditions. The landmark Action to Control Cardiovascular Risk in Diabetes (ACCORD), Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE), and VADT studies found that individualizing treatment for patients is critical to delivering the best and most appropriate care and that more data are needed in specific populations to inform these decisions (15–17). Unfortu-nately, many of the large-scale clinical studies that examine the effects of thera-pies do not capture large proportions of these patient populations. One example is the older adult population, one that is highly impacted by diabetes, but relatively understudied. The ADA recently hosted an older adult consensus conference ex-amining the specific considerations and needs of this population. The outcomes of the conference, including research pri-orities, will be published to guide the com-munity as the ADA addresses this and other important subgroups. With expand-ing numbers of therapeutic choices, a clear understanding of the benefits and risks associated with the available therapies is extremely important for clinicians to de-liver the best possible care to their patients and for patients to make informed shared decisions about their treatment.The ADA’s support for translational re-search and programs extends beyond the clinical setting. The Association understands the need to address aware-ness, behavioral and environmental bar-riers, and disparities in the community where people work and live. Modification of antecedents, including 1) awareness of prediabetes or diabetes status; 2) knowl-edge of diabetes physiology, etiology, complications, risk factors, and health be-haviors (e.g., diet, exercise, and seeking health care); 3) attitudes pertaining to health status; and 4) intentions and self-efficacy to improve behaviors, has been directly linked to decreased incidence of diabetes and complications (18–21). Un-like clinical settings, where time, support, and access are often limited, community-based programs can provide culturally and age-appropriate education and tools de-signed to modify those antecedents and, in turn, delay or prevent the onset of di-abetes, or reduce risks of its complications (22,23). To maximize the positive impact and cost-effectiveness, the ADA is currently undertaking rigorous outcomes research on its own community programs to effec-tively target its resources and to comple-ment published findings on community interventions. Moreover, the ADA research program has and will continue to fund external research to identify novel and in-novative approaches to community-based interventions. MEASURING IMPACT—With continuing economic