National Diabetes Prevention Program Offers Model for Combating Diabetes Epidemic

« SPECIAL REPORT »
Joan K. Bardsley, MBA, RN, CDE, FAADE, discusses a General Session outlining how health care providers can motivate and help patients achieve better outcomes using technology.

NEW ORLEANS — During her presentation on the National Diabetes Prevention Program (DPP), Ann Albright, RD, PhD, director of the Division of Diabetes Translation for the Centers for Disease Control and Prevention, at AADE 2015, reminded us of the state of diabetes — 29 million with diabetes and 86 million with prediabetes.

By 2025, she said, it is anticipated that one-fifth of the population will have diabetes.

Opinions vary on how to deal with this epidemic. Some focus on individuals while others feel we need to focus on policies. Albright’s contention is that we need to do both.

The National DPP used the Social Ecological Model, which focuses on individuals, institutions, community, and federal and state governments. Albright used the analogy of a jazz band where each individual instrument is wonderful, but the rich sound only occurs when all play together.

The model for dissemination and adaptation of the National DPP has four components:

1. Training the workforce that can deliver the behavior change intervention. This component needs health professionals trained in lifestyle modification where health coaches can deliver the CDC-approved curriculum. Certified diabetes educators (CDEs) can have a key role as master trainers and health coaches.
2. The programs need to apply and be recognized by the CDC. The recognized sites are posted on the National DPP website. A program registry has also been developed to collect the data for the programs.
3. Programs have been developed to deliver the intervention both in person and virtually, thus allowing an increase in scalability. The high-intensity programs are year-long and include 16 sessions. The programs allow customization with personalized information and help to separate the “need to know” from the “nice to know.” This is the foundation for why it works.

   The CDC has worked with the private and public sectors to link with the payers of health care. Medicare and Medicaid cover preventive services in A or B categories. The National DPP was classified as category B. DPP coverage will be in place by January 2016.

4. PR/Marketing is structured to support program uptake by increasing referrals to use the prevention programs.

The American Medical Association (AMA) and CDC have launched a multi-year initiative to reach more Americans with prediabetes using their collective muscle to help bridge the gap between the clinical setting and the community to achieve a healthier population. The program STAT — Screening, Testing, Acting Today — will be rolled out in January 2016. It will help get the word out about the need to address prediabetes. In addition, in January 2016, a code will be available to charge for intensive behavior counseling for prediabetes.

Albright also shared examples of population-wide strategies to address the epidemic of prediabetes. These included:

• Reducing the sale of unhealthy foods in public spaces
• Incentivizing the building of supermarkets in low-income food deserts
• Reformulating foods
• Taxing unhealthy foods and subsidizing nutritious foods
• Regulating portion sizes
• Developing and implementing land use and neighborhood design policies that support active lifestyles
• Worksite policies that promote physical activity
• Requiring comprehensive physical activity programs in schools

Albright pointed out that medications and surgical procedures do have their place. However, we need to focus on the infrastructure for lifestyle interventions. Diabetes impacts everyone directly or indirectly due to its impact on our health care system.

During her presentation, Albright was able to offer both a comprehensive systematic approach while showing diabetes educators the potential role for their expertise in the DPP implementation. The CDC’s vision as outlined by Albright will be critical in translating the outcome of the DPP research study into mainstream action.

Joan K. Bardsley, MBA RN CDE FAADE, is Assistant Vice President of Special Projects at MedStar Health Research Institute, and 2014 President of the American Association of Diabetes Educators.

Reference

1. Albright A. GS03 – Diabetes Prevention and All that Jazz. Presented at: AADE 2015; Aug. 5-8, 2015; New Orleans.