Preventing the Onset of Type 2 DiabetesFriday, May 01, 2015
The U.S. diabetes statistics are well known: 29.1 million people, or 9.3% of the American population has diabetes and 8.1 million are undiagnosed. The statistics for prediabetes are perhaps less well known but more significant for the future of American health and healthcare. 86 million Americans, or 1 in 3, have prediabetes but nearly 90 percent of these people do not know they have it. An alarming statistic signaling a tsunami of healthcare costs bearing down on an already burdened healthcare system.
Screening is the primary tool for identifying prediabetes, yet even when prediabetes is discovered the best many healthcare practices can do is give handouts and encourage patients to eat healthy and exercise more.
[Are you at risk for type 2 diabetes? Come check out our Diabetes Risk Calculator to see.]
Behavior change and compliance are complex issues, but many practices don’t have the capacity to guide patients through the long process of making lasting behavior change. That’s where the Prevent Diabetes STAT: Screen, Test, Act–Today initiative and National Diabetes Prevention Program (NDPP) Lifestyle Change Programs come in.
These are U.S. federal programs looking to adopt better screening for prediabetes and to get people treated for the condition so it does not escalate into type 2 diabetes.
Since the results of the 1996 Diabetes Prevention Program (DPP) Research Study were published in the New England Journal of Medicine in 2002, the Centers for Disease Control and Prevention (CDC) has backed the roll-out of evidence-based lifestyle change programs. The DPP study randomly assigned subjects to 3 treatment groups: lifestyle intervention (reduce weight by 7% and increase physical activity to 150 minutes/week); metformin therapy; and placebo.
The lifestyle program educated clients about the causes of diabetes then led them step-by-step through a curriculum designed to increase healthy eating and exercise. After 3 years, lifestyle change participants reduced their risk for type 2 diabetes by 58%. Findings were clear in all subjects regardless of sex, age, race or socioeconomic status. The lifestyle change approach clearly demonstrates people with pre-diabetes can prevent or delay full-blown type 2 diabetes by losing 5%-7% of body weight and getting at least 150 minutes of exercise a week.
Several institutions adapted the research study curriculum into group-based programs, and eventually used facilitators who often did not have a medical background. Diabetes lifestyle coaches are trained to deliver curriculum and facilitate groups in a variety of settings, like health care facilities and community-based organizations, especially the YMCA. The YMCA offers diabetes lifestyle change courses throughout the US. These cost-effective programs not only serve patients, but also give healthcare professionals community resources that actually deliver results. The CDC has backed and developed these programs and partnered in trainings for diabetes lifestyle coaches for over 10 years.
This year the CDC and the American Medical Association (AMA) partnered to create Prevent Diabetes STAT: Screen, Test, Act–Today a multi-year initiative to link healthcare professionals serving diabetes patients with NDPP Lifestyle Change Programs in their communities. Diabetes STAT is the next step in the larger roll-out, creating momentum and demand.
What’s required to participate in Prevent Diabetes STAT: Screen, Test, Act–Today can be found here.
Clinicians are asked to:
- Screen for prediabetes (use CDC prediabetes screening test or AMA risk test);
- Test at risk patients with 1 of 3 blood tests;
- If blood sugar levels are elevated refer them to a NDPP program in the patient's state.
There are a variety of ways healthcare providers can identify patients who could benefit from an NDPP program.
A key piece to growing these programs is making them a health insurance benefit. So far, national coverage is sparse but growing. Several states offer it as an employee benefit and a bill in Congress would make it a Medicare benefit.
Ultimately, if the U.S. is going to turn the tide on type 2 diabetes, then these important screening and preventative programs need to be part of the equation.
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