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“An Ounce of Prevention”. 2011 Diabetes Update Forum. Objectives. 1) Be familiar with the evidence supporting the role of physical activity in the prevention of chronic disease 2) Develop awareness of the American College of Sports Medicine Exercise Is Medicine program
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“An Ounce of Prevention” 2011 Diabetes Update Forum
Objectives • 1)Be familiar with the evidence supporting the role of physical activity in the prevention of chronic disease • 2)Develop awareness of the American College of Sports Medicine Exercise Is Medicine program • 3)Understand the role of health care providers in promoting physical activity with their patients • 4. Understand the importance of linking public health and clinical medicine to prevent and manage diabetes • 5. Identify strategies to improve a population health approach to prevention and management of diabetes • 6. Commit to better linking your practice to local and state public health diabetes prevention/management efforts
Our purpose is to review strategies not statistics, however…..
26 million people with diabetes • 79 million with pre-diabetes • Lifetime Risk – from birth till death About 1-in-3 or 33% (Narayan KMV, et al. JAMA 2003;290:1884-1890.) WE WILL SOON BE OVERWHELMED!
The Diabetes Prevention Program(February 7, 2002, New England Journal of Medicine) Lifestyle intervention group: • Received intensive counseling on diet, exercise, and behavior change. • Ate less fat and fewer calories. • Exercised 150 minutes a week. • Aimed to lose 7 percent of their body weight and maintain that loss. Reduced their risk of developing diabetes by 58 percent...
The Diabetes Prevention Program(February 7, 2002, New England Journal of Medicine) • Participants taking metformin reduced their risk of developing diabetes by 31 percent. • The DPP resolved the questions so quickly that, the program was halted a year early.
Primary Prevention I. Risk must match Program Cost II. Must be Effective III. Must be Economically Sustainable IV. Must be Available
HR 3590 Passed by Congress in March 2010 A grant program for community-based diabetes prevention program model sites; A program within the CDC to determine eligibility of entities to deliver community-based diabetes prevention services; A training and outreach program for lifestyle intervention instructors; and Evaluation, monitoring and technical assistance, and applied research carried out by the CDC.
The National Diabetes Prevention Program has 4 components: • Training: established the Diabetes Training and Technical Assistance Center at Emory University • Intervention sites: community sites that deliver the intervention to reduce new cases of type 2 diabetes • Health Marketing: raising awareness among both health care providers and high risk populations • Program recognition: standards that help ensure program quality and consistency
The National Diabetes Prevention Program Goal: • Systematically scale the translated model of the Diabetes Prevention Program (DPP) for high risk persons in collaboration with community-based organizations that have necessary infrastructure, health payers, health care professionals, public health, academia, and others to reduce the incidence of type 2 diabetes in the U.S.
Currently • CDC has contracted with Emory University to establish the Diabetes Training and Technical Assistance Center (DTTAC) and developed Master Trainer curriculum and unified Lifestyle Coach curriculum –info posted on website July 2011 • CDC and partners developed the standards for program recognition. The standards for the Diabetes Prevention Recognition Program are with OMB now and approval is anticipated mid-November, assuming they have no specific changes.
Currently • Intervention Sites = YMCA. UHG began providing reimbursement to these Y’s to deliver the lifestyle intervention for local employers for which UHG administers health insurance on OCTOBER 1, 2010. • Currently 122 sites for program delivery • Health Marketing = CDC contracted with MACRO to do formative PR/marketing work that will be used to develop messaging and tools – focus groups have been conducted
Benefits of DPP Treating 100 high risk adults for 3 years: •Prevents 15 new cases of type 2 diabetes (1) •Prevents 162 missed work days (2) •Avoids the need for BP/Chol pills in 11 people (3) •Adds the equivalent of 20 perfect years of health (4) •Avoids $91,400 in healthcare costs (5) 1 DPP Research Group. N Engl J Med. 2002 Feb 7;346(6):393-403 2 DPP Research Group. Diabetes Care. 2003 Sep;26(9):2693-4 3 Ratner, et al. 2005 Diabetes Care 28 (4), pp. 888-894 4 Herman, et al. 2005 Ann Intern Med 142 (5), pp. 323-32 5Ackermann, et al. 2008 Am J Prev Med 35 (4), pp. 357-363; estimates scaled to 2008 $US
Diabetes Prevention Program Outcomes Study • After 3 years a group version of the core lifestyle intervention was offered to placebo and metformin groups, as well as the original lifestyle group, including 4 group “BOOST” sessions each year • During the total 10-year follow-up, the incidences of type 2 diabetes was still reduced by 34% in the lifestyle group and by 18% in the metformin group • Lancet 2009; Published Online October 29,2009
In order to save money, DPP cost should be about $300. • The original DPP 1 on 1 Format cost was $2780 per participant for 3 years, with inflation, $3500. • The cost of the newly developed group based format is $275 -$325 per participant when using trained YMCA staff(Ackermann, et al) or $550 per participant when using CDEs (Amundsen, et al)
