Diabetes prevention at the national level
A Coordinated National Model for Diabetes Prevention: Linking Health Systems to an Evidence-Based Community Program

https://doi.org/10.1016/j.amepre.2012.12.018Get rights and content

Background

Twenty-six million U.S. adults have diabetes, and 79 million have prediabetes. A 2002 Diabetes Prevention Program research study proved the effectiveness of a lifestyle intervention that yielded a 58% reduction in conversion to type 2 diabetes. However, cost per participant was high, complicating efforts to scale up the program.

Purpose

UnitedHealth Group (UHG) and the YMCA of the USA, in collaboration with the CDC, sought to develop the infrastructure and business case to scale the congressionally authorized National Diabetes Prevention Program nationwide. Emphasis was placed on developing a model that maintained fidelity to the original 2002 Diabetes Prevention Program research study and could be deployed for a lower cost per participant while yielding similar outcomes.

Design

The UHG created the business case and technical and operational infrastructure necessary for nationwide dissemination of the YMCA's Diabetes Prevention Program (YMCA's DPP), as part of the National Diabetes Prevention Program. The YMCA's DPP is a group-based model of 16 core sessions with monthly follow-up delivered by trained lifestyle coaches.

Setting/participants

A variety of mechanisms were used to identify, screen, and encourage enrollment for people with prediabetes into the YMCA's DPP.

Intervention

Substantial investments were made in relationship building, business planning, technology, development, and operational design to deliver an effective and affordable 12-month program. The program intervention was conducted July 2010–December 2011. Data were collected on the participants over a 15-month period between September 2010 and December 2011. Data were analyzed in February 2012.

Main outcome measures

The main outcome measures were infrastructure (communities involved and personnel trained); engagement (screening and enrollment of people with prediabetes); program outcomes (attendance and weight loss); and service delivery cost of the intervention.

Results

In less than 2 years, the YMCA's DPP was effectively scaled to 46 communities in 23 states. More than 500 YMCA Lifestyle Coaches were trained. The program enrolled 2369 participants, and 1723 participants completed the core program at an average service-delivery cost of about $400 each. For those individuals completing the program, average weight loss was about 5%. UHG anticipates that within 3 years, savings from reduced medical spending will outweigh initial costs.

Conclusions

Large-scale prevention efforts can be scalable and sustainable with collaboration, health information technology, community-based delivery of evidence-based interventions, and novel payment structures that incentivize efficiency and outcomes linked to better health and lower future costs.

Section snippets

Background

Twenty-six million U.S. adults have diabetes, and 79 million have prediabetes. In 2002, a Diabetes Prevention Program research study proved the effectiveness of a lifestyle intervention that yielded a 58% reduction in conversion to type 2 diabetes. In 2010, the National Diabetes Prevention Program was created by Congress and provides the overarching architecture to organize nationwide programs to prevent diabetes through changes in lifestyle. This study describes the collaborative,

Design

Participants with prediabetes are enrolled in the YMCA's Diabetes Prevention Program (YMCA's DPP), a 12-month community-based initiative. As a service provider, the YMCA's DPP uses the DPCA infrastructure for support with tasks such as managing content and collecting patient data. Local YMCAs are compensated for successful program delivery based on enrollment, program completion and final individual participant outcomes, particularly for weight loss. Nearly 60% of the U.S. population lives

Results

In the first 18 months of operations, the YMCA's DPP was effectively scaled to 46 communities in 23 states where it was reimbursed through private payers, self-insured employers, and CDC funding. More than 500 YMCA Lifestyle Coaches have been trained to administer the lifestyle change program. As of January 31, 2012, a total of 2369 individuals have participated in the YMCA's DPP, and another 1053 are currently active in the core program. As of January 31, 2012, a total of 1723 participants

Discussion

The original 2002 Diabetes Prevention Program research study demonstrated that significant reduction in the risk of progressing from prediabetes to diabetes could be achieved, but also raises the question: Why was so little done by the wider healthcare community in the years following the publication of the research study results to bring the new intervention to scale and to ensure it had a broad impact on population health? The absence of such action illustrates one of the challenges

References (18)

  • L.S. Geiss et al.

    Diabetes risk reduction behaviors among U.S. adults with prediabetes

    Am J Prev Med

    (2010)
  • National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the U.S., 2011

    (2011)
  • Number (in millions) of civilian, non-institutionalized persons with diagnosed diabetes, U.S., 1980–2008

    (2010)
  • D. Goldman et al.

    Value of elderly disease prevention

    Forum Health Econ Policy

    (2006)
  • UnitedHealthcare employer-sponsored membership allowed costs (medical and prescription drugs) in 2009 drawn from a national sample of 10 million membersThe United States of diabetes: challenges and opportunities in the decade ahead

    (2010 Nov)
  • F. de Vegt et al.

    Relation of impaired fasting and postload glucose with incident type 2 diabetes in a Dutch population: the Hoorn Study

    JAMA

    (2001)
  • Screening for type 2 diabetes mellitus in adults, topic pageUSPSTF

    (2008)
  • Standards of medical care in diabetes

    Diabetes Care

    (2010)
  • D. Vojta et al.

    Effective interventions for stemming the growing crisis of diabetes and prediabetes: a national payer's perspective

    Health Aff (Millwood)

    (2012)
There are more references available in the full text version of this article.

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