The Diabetes Prevention Program

Eighty-four million people — upwards of one-third of U.S. adults — have prediabetes. More shocking is that nine out of 10 don’t know they have it. If not addressed, prediabetes can lead to Type 2 diabetes in as little as five years. Prediabetes also increases the risk of having a heart attack or stroke.

Many times, the “pre” in prediabetes leads those with the disorder to have a false sense of security. Many believe that there is nothing to worry about — not yet, anyway, since, “I don’t really have diabetes yet.” However, now is the time to take action. Knowing your risk and becoming informed about the lifestyle changes that can prevent or delay Type 2 diabetes are the first steps in the right direction. So how can you take control and navigate your way toward diabetes prevention?

What is the Diabetes Prevention Program?

Research led by the National Institutes of Health showed that adults with prediabetes who participate in a structured lifestyle program could cut the risk of developing Type 2 diabetes by 58 percent. For people over the age of 60, that risk was lowered by 71 percent. Risk was decreased through modest weight loss of five percent of their body weight, and physical activity, at least 150 minutes each week.

The good news is that an evidence-based program, the National Diabetes Prevention Program (National DPP) sponsored by the Centers for Disease Control and Prevention (CDC), has been created to reduce the risk of developing Type 2 diabetes. The National DPP is a structured lifestyle change program that focuses on making healthy and gradual changes for lifelong success.

The year-long program has classes that meet either weekly or biweekly for the first six months and then one to two times per month after. Programs can be both in-person and online. Through interactive group classes led by a trained lifestyle coach, participants learn about healthy food choices, reducing stress, physical activity and problem-solving. Each class brings a new topic and, with it, ways to incorporate these new habits into daily life. The goal is for participants to lose at least five to seven percent of their body weight and to include at least 150 minutes of physical activity each week.

Who can participate?

These lifestyle programs are designed for people who are at high risk for or have prediabetes. According to the CDC guidelines, to join a National DPP lifestyle change program, you must:

• be at least 18 years old and
• be overweight (body-mass index [BMI] ≥25; ≥23 if Asian American), and
• have a blood test result in the prediabetes range within the past year:
• hemoglobin A1C: 5.7 to 6.4 percent, or
• fasting plasma glucose: 100 to 125 mg/dL, or
• two-hour plasma glucose (after a 75 gm glucose load): 140 to 199 mg/dL, or
• be previously diagnosed with gestational diabetes.

The CDC guidelines allow individuals who are 18 or older and overweight (as described earlier) to attend the National DPP if they screen positive by taking a risk test such as the CDC Prediabetes Screening Test.

You are not eligible for the program if you already have Type 1 or Type 2 diabetes. You would not be enrolled if you are pregnant.

How do I get started?

Three steps can help you get moving toward your new, healthier lifestyle.

1. Ask your provider for a referral to a National DPP.

2. If your provider does know where to find a program, be proactive. Find a National DPP program near you. Make sure it is a CDC-recognized program to ensure you are joining a program of high quality.

3. Attend an informational session to learn more about the information you will receive and the benefits you will gain.

What is the cost?

The cost of participating in a National DPP varies, depending on where you live, what organization is offering the program and what type of program it is. Contact the program you would like to join to determine the cost and payment options. Some employers and insurance plans cover the cost of the National DPP. Check with your employer or insurance company to see if a program is covered. As well, you may be able to use a flexible spending plan option, and most programs should be able to provide the documentation you will need for your plan. As of April 1, 2018, the Centers for Medicare and Medicaid Services (CMS) have expanded services so that all eligible Medicare patients will receive the Medicare Diabetes Prevention Program (MDPP) as a covered benefit.

Good news for older adults

Prediabetes affects over 25 percent of Americans 65 years and older, and only 14 percent are aware they have the condition. The addition of Medicare coverage of the CDC National DPP is an opportunity for older adults to commit to a healthier lifestyle and decrease the risk of developing Type 2 diabetes and the complications that can accompany the disease.

Patients enrolled in Medicare Part B are eligible for the MDPP benefit if they meet the following requirements:

• BMI ≥25, or if Asian American, ≥23.
• lab value in the prediabetes range determined by one of the following:
HbA1C: 5.7 to 6.4 percent;
Fasting plasma glucose: 110 to 125 mg/dL (this range is slightly different for Medicare); or
two-hour plasma glucose tolerance test of 140-199 mg/dL;
• no previous Type 1 or Type 2 diabetes diagnosis; and
• no current diagnosis of end-stage renal disease.

The Medicare DPP lifestyle program is structured similarly to the National DPP. Participants attend weekly or biweekly meetings for the first six months followed by six months of monthly check-ins to ensure participants continue their path to success. As an additional Medicare benefit, participants who maintain five percent weight loss (or more) will also be eligible to receive up to one additional year of monthly maintenance sessions. The availability of a CDC-recognized lifestyle change program as a covered Medicare benefit is a major bonus for seniors.

What happens after I complete a National DPP?

During the year long program, participants and their lifestyle coaches form a close bond. Some groups develop methods to communicate with each other when the year is over to keep that strong support system they have come to rely on. Patients can turn to both online and in-person resources for ongoing support in their journey to healthier living.

Take action

Now is the time. If Type 2 diabetes runs in your family, you are at higher risk for the disease. Knowing that prediabetes usually comes first, take the prediabetes risk test. If your score indicates prediabetes, ask your health-care provider for a blood test to confirm the diagnosis. Then locate a National DPP to help you prevent or delay Type 2 diabetes.