COMMENTARY

Prediabetes: Stopping a Runaway Train

Anne Albright, PhD, RD

Disclosures

January 19, 2016

Editorial Collaboration

Medscape &

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Hello. I'm Dr Ann Albright, director of the Division of Diabetes Translation at the Centers for Disease Control and Prevention (CDC). I'm speaking with you as part of the CDC Expert Commentary Series on Medscape.

As you know, prediabetes is a treatable health condition characterized by blood glucose levels that are abnormally elevated but are not high enough yet to be classified as type 2 diabetes. Prediabetes increases the risk for type 2 diabetes, heart disease, and stroke. The facts are clear:

  • 86 million people in the United States have prediabetes—and 9 out of 10 of them do not know they have it.

  • Recent studies suggest that 1 out of 3 people over the age of 18, and half of people over age 65, have prediabetes.

  • Without lifestyle changes to improve their health, 15%-30% of people with prediabetes will develop type 2 diabetes within 5 years.[1]

The good news is that there is an effective treatment that can prevent or delay type 2 diabetes in those at high risk. That treatment is a structured lifestyle program that provides real-life support for healthful eating, increasing physical activity, and enhancing problem-solving skills. The growing confirmation that evidence-based lifestyle interventions are effective in reducing cardiometabolic risk is encouraging and motivating.

Today I will discuss two recent recommendations that can improve the health outcomes of your patients with cardiometabolic risk. In August 2014, the US Preventive Services Task Force (USPSTF) published its final recommendation statement and evidence summary on behavioral counseling to prevent cardiovascular disease (CVD) in at-risk adults.[2] The USPSTF recommends that adults who are overweight or obese and who also have at least one risk factor for cardiovascular disease (including prediabetes) be offered or referred to behavioral counseling interventions to promote a healthy diet and physical activity to help prevent the disease. This is an official grade B recommendation, which means that coverage by most health plans is required.

The USPSTF found adequate evidence that intensive behavioral counseling interventions have moderate benefits for cardiometabolic risk in overweight or obese adults who are at increased risk for CVD, including reductions in blood pressure, lipids, and fasting glucose. The reduction in glucose levels was large enough to reduce the incidence of diabetes.[2]

On July 14, 2015, the Community Preventive Services Task Force recommended combined diet and physical activity promotion programs for people at increased risk for type 2 diabetes, based on strong evidence of effectiveness in reducing new-onset diabetes.[3] Combined diet and physical activity promotion programs also increase the likelihood of reverting to normoglycemia and improve diabetes and CVD risk factors, including overweight, high blood glucose, high blood pressure, and abnormal lipid profiles. The Task Force also concluded from the economic evidence that combined diet and physical activity promotion programs to prevent type 2 diabetes among people at increased risk are cost-effective.

So, what is being done to make these recommendations a reality for your patients? And what can you do? CDC and its grantees and partners are working diligently to make these recommendations a reality, and you have an important role in these efforts.

The National Diabetes Prevention Program established by CDC, is a coordinated effort to bring evidence-based lifestyle change programs to Americans at high risk for type 2 diabetes. Programs are implemented locally and scaled for national impact. The program is a collaboration among government agencies, community-based organizations, businesses, employers, insurers, healthcare professionals, and others to make these diabetes prevention resources more broadly accessible and affordable.

The National Diabetes Prevention Program's evidence-based lifestyle change intervention can help individuals prevent or delay type 2 diabetes. Participants in the interventions learn about making real, sustainable lifestyle changes such as eating healthier, including physical activity in their daily lives, and improving problem-solving and coping skills.

The lifestyle intervention is based on sound behavioral change principles, is kept relatively simple, and gives participants the necessary dose of counseling and tools to make healthier choices. The program can be offered almost anywhere that a small group can gather—churches, office buildings, and community centers—and now it is also offered online.

The evidence is strong. These programs work. Both randomized clinical trials and real-world implementation studies prove that structured lifestyle change programs can help prevent or delay type 2 diabetes by about 60% in people with prediabetes.[4,5] This intervention is also cost-effective. Some healthcare insurers already cover the costs associated with the program, and we are working every day to expand that coverage nationally.

To ensure program quality, CDC set standards and established a Diabetes Prevention Recognition Program, the purpose of which is to certify organizations that have shown that they can effectively deliver the lifestyle change program. CDC tracks the progress of the organizations offering the program, ensuring that they consistently meet the same quality standards across the country. You can confidently refer your patients to CDC-recognized programs. Currently, more than 650 of these programs exist across the country, including online options.

In March 2015, as part of the National Diabetes Prevention Program, the CDC and the American Medical Association (AMA) joined forces to take urgent action to Prevent Diabetes STAT: Screen, Test, Act – Today™. We are urging others, like you, to join in this critical effort. Prevent Diabetes STAT is a multiyear initiative that expands on the robust work that each organization has already begun to reach more Americans with prediabetes and to stop the progression to type 2 diabetes, one of our nation's most debilitating chronic diseases.

These efforts are critical for people with prediabetes—and you are critical to their success. As a healthcare provider you can:

  • Screen and test your patients for prediabetes. Research shows that communicating these results significantly affects whether your patients take action.

  • Refer your patients with prediabetes to a CDC-recognized prevention program. Your referral matters to your patients.

  • Be a champion for the National Diabetes Prevention Program—your support will help increase access to this resource.

  • Join CDC and AMA to "Prevent Diabetes STAT." By screening and testing your patients for prediabetes, and referring patients with prediabetes to a CDC-recognized lifestyle prevention program, you will already be a part of Prevent Diabetes STAT.

  • Download the Prevent Diabetes STAT Toolkit for healthcare providers.

  • Share your involvement in the Prevent Diabetes STAT initiative with your colleagues. Encourage them to join in these critical efforts as well.

  • For more information and to find programs near you, please visit our website designed for healthcare professionals, which includes screening tools, patient education materials, referral forms, and billing and coding information.

Thank you for all you do to help people prevent and delay type 2 diabetes.

Web Resources

Division of Diabetes Translation

National Diabetes Prevention Program

Diabetes Prevention Recognition Program

National Diabetes Statistics Report, 2014

Diabetes Public Health Resource: Registry of Recognized Programs

Prevent Diabetes STAT: Screen, Test, Act - Today

Ann Albright, PhD, RD, is the director of the Division of Diabetes Translation at the Centers for Disease Control and Prevention, where she leads an expert team striving to eliminate the preventable burden of diabetes through leadership, research, programs, and policies that translate science into practice. Prior to commencing her post at the CDC, Dr Albright served as chief of the California Diabetes Program for the California Department of Health Services. During this time, she also held an academic appointment in the Institute for Health and Aging at University of California, San Francisco. Dr Albright served as the senior health policy advisor in the Office of the United States Surgeon General and led the Secretary of Health's Diabetes Detection Initiative. Dr Albright is well known for her work in diabetes, including the implementation of evidence-based diabetes care guidelines, work on models of care in community clinics, application of diabetes prevention, and development of campaigns to increase the understanding of diabetes and importance of blood glucose, blood pressure, and lipid control.

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