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Practical Tips for Implementing the Diabetes Prevention Program in Clinical Practice

  • Health Care Delivery Systems and Implementation in Diabetes (ME McDonnell and AR Sadhu, Section Editors)
  • Published:
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Abstract

Purpose of Review

The Diabetes Prevention Program (DPP) is an evidence-based lifestyle change program for prediabetes that is associated with a 58% reduction in 3-year diabetes incidence, and it has been supported by the American Medical Association and the Centers for Disease Control and Prevention. However, 9 in 10 patients are unaware they have the condition.

Recent Findings

With the passage of the Affordable Care Act (ACA) and broadened coverage for preventive services, the DPP has emerged as an accessible intervention in patients at risk. In 2018, Medicare began to cover the DPP, making it widely available for the first time to any patient over the age of 65 meeting eligibility criteria.

Summary

The DPP is an evidence-based, widely available, frequently covered benefit, for lifestyle change for patients with prediabetes. To take advantage of this intervention, providers need to develop prediabetes screening and DPP referral workflows.

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References

Papers of particular interest, published recently, have been highlighted as: •• Of major Importance

  1. Centers for Disease Control and Prevention. National Diabetes Statistics Report. Estimates of diabetes and its burden in the United States, 2014. Atlanta, GA; 2014.

  2. Centers for Disease Control and Prevention. Awareness of prediabetes—United States, 2005-2010. MMWR Morb Mortal Wkly Rep. 2013;62(11):209–12.

    Google Scholar 

  3. Centers for Disease Control and Prevention. National Diabetes Statistics Report. Atlanta, GA: Centers for disease control and prevention, US Department of Health and Human Services; 2017.

  4. Heron M, Anderson R. Changes in the leading cause of death: recent patterns in heart disease and cancer mortality. Hyattsville, MD; 2016.

  5. Centers for Disease Control and Prevention. The cost of diabetes 2016 [Available from: http://www.diabetes.org/advocacy/news-events/cost-of-diabetes.html?referrer=https://www.google.com/.

  6. Su W, Chen F, Dall TM, Iacobucci W, Perreault L. Return on investment for digital behavioral counseling in patients with prediabetes and cardiovascular disease. Prev Chronic Dis. 2016;13:E13.

    Article  PubMed  PubMed Central  Google Scholar 

  7. American Diabetes Association. Standards of medical Care in Diabetes—2018. Diabetes Care. 2018;41(Supplement 1):S1–2. https://doi.org/10.2337/dc18-Sint01.

    Article  Google Scholar 

  8. Sussman JB, Kent DM, Nelson JP, Hayward RA. Improving diabetes prevention with benefit based tailored treatment: risk based reanalysis of diabetes prevention program. BMJ. 2015;350:h454.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403.

    Article  PubMed  CAS  Google Scholar 

  10. Ratner R, Goldberg R, Haffner S, Marcovina S, Orchard T, Fowler S, et al. Impact of intensive lifestyle and metformin therapy on cardiovascular disease risk factors in the diabetes prevention program. Diabetes Care. 2005;28(4):888–94.

    Article  PubMed  Google Scholar 

  11. Centers for Disease Control and Prevention. Diabetes prevention recognition standards: standards and operating procedures. March 1, 2018. https://www.cdc.gov/diabetes/prevention/pdf/dprp-standards.pdf.

  12. •• American Medical Association. Prevent Diabetes STAT Toolkit 2016 [Available from: https://assets.ama-assn.org/sub/prevent-diabetes-stat/toolkit.html. This toolkit is an essential resource for providers considering implementing the DPP program in their clinical practice.

  13. Centers for Disease Control and Prevention. National Diabetes Prevention Program 2016 [Available from: https://www.cdc.gov/diabetes/prevention/lifestyle-program/deliverers/index.html.

  14. Siu AL, Force USPST. Screening for abnormal blood glucose and type 2 diabetes mellitus: U.S. preventive services task force recommendation statement. Ann Intern Med. 2015;163(11):861–8.

    Article  PubMed  Google Scholar 

  15. •• Tice J CR, Shore K, et al.. Diabetes prevention programs: effectiveness and value. final evidence report and meeting summary. Boston, MA; 2016. This report provides an in-depth look at the clinical impact and return on investement for the Diabetes Prevention Program.

  16. Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2018; Medicare Shared Savings Program Requirements; and Medicare Diabetes Prevention Program. 42 CFR Parts 405, 410, 414, 424, and 425 (2017).

  17. Ima J, Yank V, Xiao L, Lavori PW, Wilson SR, Rosas LG, et al. Translating the diabetes prevention program lifestyle intervention for weight loss into primary care: a randomized trial. JAMA Intern Med. 2013;173(2):113–21.

    Article  Google Scholar 

  18. Ackermann RT, Finch EA, Brizendine E, Zhou H, Marrero DG. Translating the diabetes prevention program into the community. The DEPLOY Pilot Study. Am J Prev Med. 2008;35(4):357–63.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Ely EK, Gruss SM, Luman ET, Gregg EW, Ali MK, Nhim K, et al. A national effort to prevent type 2 diabetes: participant-level evaluation of CDC's national diabetes prevention program. Diabetes Care. 2017;40:1331–41.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Hamman RF, Wing RR, Edelstein SL, Lachin JM, Bray GA, Delahanty L, et al. Effect of weight loss with lifestyle intervention on risk of diabetes. Diabetes Care. 2006;29(9):2102–7.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Maruthur NM, Ma Y, Delahanty LM, Nelson JA, Aroda V, White NH, et al. Early response to preventive strategies in the diabetes prevention program. J Gen Intern Med. 2013;28(12):1629–36.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Diabetes Prevention Program Research Group. Long-term effects of lifestyle intervention or metformin on diabetes development and microvascular complications over 15-year follow-up: the diabetes prevention program outcomes study. Lancet Diabetes Endocrinol. 2015;3(11):866–75.

    Article  PubMed Central  CAS  Google Scholar 

  23. Michaelides A, Raby C, Wood M, Farr K, Toro-Ramos T. Weight loss efficacy of a novel mobile diabetes prevention program delivery platform with human coaching. BMJ Open Diabetes Res Care. 2016;4(1):e000264.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Sepah SC, Jiang L, Peters AL. Translating the diabetes prevention program into an online social network: validation against CDC standards. Diabetes Educ. 2014;40(4):435–43.

    Article  PubMed  Google Scholar 

  25. Sepah SC, Jiang L, Peters AL. Long-term outcomes of a web-based diabetes prevention program: 2-year results of a single-arm longitudinal study. J Med Internet Res. 2015;17(4):e92.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Chen F, Su W, Becker SH, Payne M, Castro Sweet CM, Peters AL, et al. Clinical and economic impact of a digital, remotely-delivered intensive behavioral counseling program on Medicare beneficiaries at risk for diabetes and cardiovascular disease. PLoS One. 2016;11(10):e0163627.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Khan T, Tsipas S, Wozniak G. Medical care expenditures for individuals with prediabetes: the potential cost savings in reducing the risk of developing diabetes. Popul Health Manag. 2017;20:389–96.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Institute for Clinical and Economic Review. Diabetes Prevention Programs: Effectiveness and Value. Final evidence report and meeting summary. 2016.

  29. Li R, Qu S, Zhang P, Chattopadhyay S, Gregg EW, Albright A, et al. Economic evaluation of combined diet and physical activity promotion programs to prevent type 2 diabetes among persons at increased risk: a systematic review for the community preventive services task force. Ann Intern Med. 2015;163(6):452–60.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Diabetes Prevention Program Research Group. The 10-year cost-effectiveness of lifestyle intervention or metformin for diabetes prevention: an intent-to-treat analysis of the DPP/DPPOS. Diabetes Care. 2012;35(4):723–30.

    Article  CAS  Google Scholar 

  31. Herman WH. The cost-effectiveness of diabetes prevention: results from the diabetes prevention program and the diabetes prevention program outcomes study. Clin Diabetes Endocrinol. 2015;1:9.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Buysschaert M, Medina JL, Buysschaert B, Bergman M. Definitions (and current controversies) of diabetes and prediabetes. Curr Diabetes Rev. 2016;12(1):8–13.

    Article  PubMed  CAS  Google Scholar 

  33. Bullard KM, Williamson DF, Imperatore G, Gregg E. Identification of US adults with pre-diabetes or undiagnosed diabetes using a simple risk score. Atlanta: American Diabetes Association Conference; 2011.

    Google Scholar 

  34. Bang H, Edwards AM, Bomback AS, Ballantyne CM, Brillon D, Callahan MA, et al. Development and validation of a patient self-assessment score for diabetes risk. Ann Intern Med. 2009;151(11):775–83.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Diabetes Prevention Program Research Group. The diabetes prevention program (DPP): description of lifestyle intervention. Diabetes Care. 2002;25(12):2165–71.

    Article  Google Scholar 

  36. Tseng E, Greer RC, O'Rourke P, Yeh HC, McGuire MM, Clark JM, et al. Survey of primary care providers’ knowledge of screening for, diagnosing and managing prediabetes. J Gen Intern Med. 2017;32:1172–8.

    Article  PubMed  Google Scholar 

  37. Schmittdiel JA, Adams SR, Segal J, Griffin MR, Roumie CL, Ohnsorg K, et al. Novel use and utility of integrated electronic health records to assess rates of prediabetes recognition and treatment: brief report from an integrated electronic health records pilot study. Diabetes Care. 2014;37(2):565–8.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Centers for Disease Control and Prevention. Preventing diabetes: a guide to refer your patients with prediabetes to an evidence-based diabetes prevention program. 2015.

  39. Fontil V, McDermott K, Tieu L, Rios C, Gibson E, Sweet CC, et al. Adaptation and feasibility study of a digital health program to prevent diabetes among low-income patients: results from a partnership between a digital health company and an academic research team. J Diabetes Res. 2016;2016:8472391.

    Article  PubMed  PubMed Central  Google Scholar 

  40. West DS, Elaine Prewitt T, Bursac Z, Felix HC. Weight loss of black, white, and Hispanic men and women in the diabetes prevention program. Obesity (Silver Spring). 2008;16(6):1413–20.

    Article  Google Scholar 

  41. Rehm CD, Marquez ME, Spurrell-Huss E, Hollingsworth N, Parsons AS. Lessons from launching the diabetes prevention program in a large integrated health care delivery system: a case study. Popul Health Manag. 2017;20:262–70.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

Thank you to Shannon Haffey, MHSA, and Annalynn Skipper, PhD, RD, at the AMA for thoughtful review of the manuscript.

Author information

Authors and Affiliations

  1. Omada Health, Inc., 500 Sansome Street, San Francisco, CA, 94111, USA

    Carolyn Bradner Jasik

  2. Department of Pediatrics, University of California, San Francisco, CA, USA

    Carolyn Bradner Jasik

  3. Community Health, Intermountain Healthcare, 389 S 900 E, Salt Lake City, UT, 84102, USA

    Elizabeth Joy

  4. Family & Preventive Medicine, University of Utah, 389 S 900 E, Salt Lake City, UT, 84102, USA

    Elizabeth Joy

  5. Institute for Healthcare Delivery Research, Intermountain Healthcare, 389 S 900 E, Salt Lake City, UT, 84102, USA

    Kimberly D. Brunisholz

  6. Division of Epidemiology, University of Utah, 389 S 900 E, Salt Lake City, UT, 84102, USA

    Kimberly D. Brunisholz

  7. American Medical Association, American Medical Association 330 N Wabash Ave, Chicago, IL, 60611, USA

    Katherine Kirley

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  1. Carolyn Bradner Jasik
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Corresponding author

Correspondence to Carolyn Bradner Jasik.

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Conflict of Interest

Carolyn Bradner Jasik is employed by Omada Health, Inc. and owns stock in the company. This company is referenced (among others) in the manuscript. She also owns stock in Mango Health, Inc. This company does medication adherence programming, which is not referenced in this manuscript.

Elizabeth Joy reports grants from the America Medical Association.

Kimberly D. Brunisholz and Katherine Kirley declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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The views expressed in this article are those of the authors and should not be interpreted as American Medical Association policy.

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This article is part of the Topical Collection on Health Care Delivery Systems and Implementation in Diabetes

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Jasik, C.B., Joy, E., Brunisholz, K.D. et al. Practical Tips for Implementing the Diabetes Prevention Program in Clinical Practice. Curr Diab Rep 18, 70 (2018). https://doi.org/10.1007/s11892-018-1034-0

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  • DOI: https://doi.org/10.1007/s11892-018-1034-0

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