COMMENTARY

National Diabetes Prevention Program: What You Need to Know by January 1, 2018

Jay H. Shubrook, DO

Disclosures

November 28, 2017

Editor's Note:

On November 15, 2017, the Centers for Medicare & Medicaid Services announced that the implementation date for payment of diabetes prevention services was delayed from the original date of January 1, 2018 to April 1, 2018. Medi-Cal has also delayed implementation of diabetes prevention programs for its members, with the start date not yet determined.

I am Jay Shubrook, DO, professor in the Department of Primary Care at Touro University California, in Vallejo. Today's topic is the National Diabetes Prevention Program (NDDP).

We all know about prediabetes in the United States.

It is common, affecting one third of Americans.[1] Without any intervention, we know that about 11% of those with prediabetes will go on to develop type 2 diabetes each year.[2] Further, more than 90% of the people with prediabetes don't know that they have it.[3]

This is important because there are no hallmark signs or symptoms; there is no way to let a patient know that they have prediabetes, and people often misjudge their risk for diabetes.

We actually have very simple and affordable screening tests for prediabetes. Why is it important to use these tests? Because one third of people who are diagnosed with diabetes will have a complication on the day that they are diagnosed. This is why we must move our efforts upstream. We have had evidence for more than 10 years that we can delay or prevent type 2 diabetes.[4]

What is that evidence? Multiple studies have shown that we can change the trajectory that takes people from prediabetes to diabetes type 2.

The program we'll talk about today is the Diabetes Prevention Program.[5,6] This was a large study of more than 3000 participants which truly reflected the population of the United States. Participants were randomly assigned to receive metformin, routine care, or an intensive lifestyle intervention for 1 year.

That 1-year intensive lifestyle intervention reduced the relative risk of developing new-onset type 2 diabetes by a substantial 58%.

Within the first half of the year-long study, outcomes in the lifestyle intervention group were found to be substantially different from outcomes in the placebo and metformin groups. Throughout the 4 years of follow-up, the lifestyle intervention group continued to have much lower rates of type 2 diabetes.

How about older adults? We often think that something like this will not be as effective in our older adults. This study showed just the opposite.

The oldest group, those over the age of 60 years, received the greatest benefit from the Diabetes Prevention Program, with a 71% reduction in new-onset type 2 diabetes.

Lifestyle interventions are difficult to maintain, and many people in the Diabetes Prevention Program regained their weight. By 10 years, their weight was very similar to that of those in the metformin arm, but they continued to see a 30% reduction in new-onset type 2 diabetes even 10 years later.[5,6]

At that point, the Diabetes Prevention Program was changed from a study to a community-based program supported by the Centers for Disease Control and Prevention (CDC). The National Diabetes Prevention Program (NDPP)—a year-long, 22- to 24-class group intervention—has three goals: for participants to lose 7% of their weight at 1 year; increase physical activity to at least 150 minutes per week; and cut the amount of fat calories, with the overall outcome of reducing the rate of new-onset type 2 diabetes.

This program has been implemented all over the country and is available to your patients. It is largely supported by the CDC and other major organizations.

The program will become even more important for you because starting January 1, 2018, the Centers for Medicare & Medicaid Services (CMS) has stipulated that the NDPP will be a mandated coverage benefit and available to all their participants. This can help you and it can help your patients. Many private insurance plans already cover it. California’s Medi-Cal will cover the program beginning July 2018. CalPERS (the California Public Employees' Retirement System) and many private insurance plans actually cover it today.

If you want to know more about the NDPP, the curriculum is free and open to the public. You can go to the website, look at the curriculum, and find a program close to you. Because this is something that will be covered, patients are going to want it and it is something that can really help you in your practice.

I encourage you to go to the website and learn about the NDDP and how it can help you in your practice.

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