Ronald T. Ackermann, MD, MPH

Disclosures

August 05, 2015

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Back in 2003, when the results of the Diabetes Prevention Program (DPP)[1] were being published and widely disseminated from the New England Journal of Medicine, I joined the faculty at Indiana University and began working with Dr David Marrero, who had been one of the DPP architects. At that time, we had the idea of trying to implement the DPP outside of a research setting. Specifically, I was interested in whether we could connect patients in a primary care setting to the DPP, but I knew in my heart that it would be very difficult to deliver the program in a healthcare setting.

We reached out to local community organizations, one of which was the YMCA of Greater Indianapolis. The YMCA was very interested in collaborating on the development of a different version of the DPP that would deliver it in the same sequence and with the same types of intervention lessons, but in a group format. Together, we developed a model that trained YMCA wellness instructors to deliver the DPP in YMCA settings, and we embarked on a series of research studies to show whether it could be effective.

One of our first studies was DEPLOY.[2] DEPLOY found that the YMCA could, in fact, implement the DPP successfully. They delivered it with very high fidelity and were able to achieve 6% weight loss in people who participated, similar to the results of the original DPP clinical trial. We followed the study out to 28 months, and people still had more than 5% weight loss at that point in time.[3]

After the DEPLOY study, we began doing larger trials. One such trial was called RAPID, the results of which will be published soon in the American Journal of Public Health. We will report the results of a large randomized trial of the YMCA's DPP program in a very diverse population of people. More than 50% of participants were African American and very poor. That study also showed weight loss greater than 5% when people took part in the YMCA's DPP program. Those are exciting results that we will see soon.

We are now following this program, and it has taken on a life of its own. After the YMCA of Greater Indianapolis developed this program, they shared it with the YMCA of the USA. Over the past 5-6 years, the YMCA of the USA has partnered with UnitedHealthcare and other organizations, such as the Centers for Disease Control and Prevention, to deliver this version of the DPP to 43 states and more than 1000 different settings.

We are very excited to be evaluating the results of that program and demonstrating that the costs of the program are much lower than they were for the original DPP—about $200-$240 per person in the first year, compared with the original DPP cost of about $1500 in the first year. We are also showing that UnitedHealthcare actually saves on healthcare expenditures for individuals who participate in the DPP.

It takes 2-3 years and it is not a big cost savings, but this will be one of the first studies showing that prevention programs and lifestyle interventions don't cost extra money. They cost some money up front, but in a 2-year period, the payor will begin to save money.

We are very excited to have started with the DPP and taken it all the way forward, and to continue to evaluate the program as it lives and breathes and continues to grow.

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