Prevent Diabetes STAT | Health Care Professionals

Prediabetes is a condition in which blood glucose or hemoglobin A1C (HbA1C) levels are higher than normal but not high enough yet to be diagnosed as type 2 diabetes.

To help prevent type 2 diabetes, the American Medical Association and the Centers for Disease Control and Prevention developed a toolkit to help health care teams screen, test and refer at risk patients to in-person or online diabetes prevention programs.

PREVALENCE & BURDEN

IMPACT OF PREDIABETES

84 MILLION ADULTS HAVE PREDIABETES¹

9 OF 10 DON'T KNOW THEY HAVE PREDIABETES²

1 IN 3 ADULTS HAS PREDIABETES¹

One in two, age 65 plus have prediabetes

Prediabetes is a reversible condition.

Care teams play a significant role and there is a solution — the National Diabetes Prevention Program (National DPP).
This evidence-based intervention has been proven to motivate and support individuals to make practical, real-life and lasting change, and reduce progression to type 2 diabetes.³

Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2017. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Dept of Health and Human Services; 2017
Centers for Disease Control and Prevention (CDC). Awareness of prediabetes--United States, 2005-2010. MMWR Morb Mortal Wkly Rep. 2013 Mar 22;62(11):209-12.
Knowler WC, Barrett-Conner E, Fowler SE, et al; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393–403.

WHY ACT NOW?

Compared to people without diabetes, those with diabetes are:

80% more likely to be hospitalized for heart attack

50% more likely to be hospitalized for a stroke

70% more likely to die from heart disease or stroke

By referring patients to the National DPP, a lifestyle change program, you can help them lower their risk of developing type 2 diabetes as well as reduce the likelihood of:

Gillespie CD, Hurvitz KA; Centers for Disease Control and Prevention (CDC). Prevalence of hypertension and controlled hypertension - United States, 2007-2010. MMWR Suppl. 2013;62(3):144-8.
Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2014.

PROGRESSION FROM PREDIABETES TO DIABETES

Without intervention, depending on where an individual is on the prediabetes spectrum:

15% - 30%
OF PEOPLE WITH PREDIABETES¹

TYPE 2 DIABETES

The population with prediabetes is heterogeneous and those at the higher end of the prediabetes spectrum have a higher risk of developing type 2 diabetes.

http://www.cdc.gov/diabetes/pubs/statsreport14/prediabetes-infographic.pdf View Source

COST OF DIAGNOSED DIABETES¹

Total estimated cost in 2017: $327 billion

$237B IN DIRECT MEDICAL COSTS

$90 B IN REDUCED PRODUCTIVITY

$16,750 / YR AVG. MEDICAL EXPENSES

$9,600 / YR AVG. DIABETES EXPENSES

2.3X HIGHER EXPENSES THAN THOSE w/o DIABETES

>1 IN 4 HEALTH CARE DOLLARS

American Diabetes Association. Economic Costs of Diabetes in the US in 2017. Diabetes Care. 2018; 41(5): 917-928.

PATIENT IDENTIFICATION

PREDIABETES TESTING¹

There are 3 standard test options to identify prediabetes.

Chart showing normal, prediabetes and diabetes values for A1C, fasting plasma glucose and oral glucose tolerance

Review results for prediabetes, not just diabetes, and talk with your patient. Repeat test to confirm is recommended.

American Diabetes Association. Diabetes advocacy. Sec. 14. In Standards of Medical Care in Diabetes — 2016. Diabetes Care. 2016;39(Suppl. 1):S105—S106.

RISK ASSESSMENT CRITERIA & FREQUENCY¹

USPSTF standards suggest testing patients every 3 years.

AGE & BMI

Grade B recommendation

40-70 age AND
BMI ≥ 25

*The American Diabetes Association encourages screening for diabetes at a BMI of ≥ 23 for Asian Americans

Siu AL. U S Preventive Services Task Force. Screening for Abnormal Blood Glucose and Type 2 Diabetes Mellitus: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2015;163(11):861-8.

RISK ASSESSMENT CRITERIA & FREQUENCY (continued)¹

USPSTF standards suggest testing patients every 3 years.
Consider testing adults of a lower age or BMI if risk factors present.

FAMILY HISTORY

Family history of type 2 diabetes includes first-degree relatives (a person’s parent, sibling, or child)

MEDICAL HISTORY

Gestational diabetes
Polycystic ovary syndrome

RACIAL & ETHNIC MINORITIES

African Americans
American Indians or Alaskan Natives
Asian Americans
Hispanics or Latinos
Native Hawaiians or Pacific Islanders

Siu AL. U S Preventive Services Task Force. Screening for Abnormal Blood Glucose and Type 2 Diabetes Mellitus: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2015;163(11):861-8.

TREATMENT

RANDOMIZED CONTROLLED TRIAL RESULTS¹

DPP Research Study: People with prediabetes who took part in a structured lifestyle change program reduced their risk of developing type 2 diabetes (at average follow-up of 3 years) compared to placebo. And the lifestyle change program was nearly twice as effiective as metformin.

DPP

Intensive Lifestyle Change Program

(71% reduction for patients over age 60)

METFORMIN

Glucose Lowering Drug

(Currently, there is no FDA approval for metformin for the indication of diabetes prevention)

Knowler et al. N Engl J Med 2002;346:393-403.

RANDOMIZED CONTROLLED TRIAL IMPACT

DPP clinical impact:

(over 3 years, after program completion per 100 high-risk adults)

15 FEWER NEW CASES OF DIABETES¹

8 FEWER PATIENTS USING ANTI-HYPERTENSIVE MEDICATION²

4 FEWER PATIENTS USING ANTI-LIPID MEDICATION²

Knowler et al. N Engl J Med 2002;346:393-403.
The DPP Research Group. Impact of lifestyle and metformin therapy on cardiovascular disease risk factors in the diabetes prevention program. Diabetes Care. 2005;28(4):888-894.

NATIONAL DPP

The CDC-led National DPP is based on the evidence from the original DPP research study and subsequent effectiveness studies, and is proven to be effective. Patients work with a trained lifestyle coach and a small group of other patients focused on making lasting lifestyle changes.

PHYSICAL ACTIVITY, 150 MINUTES/WEEK

HEALTHY EATING

STRESS MANAGEMENT & BEHAVIOR MODIFICATION

Year-long in-person or online lifestyle change program

FIRST 6 MONTHS
weekly curriculum

NEXT 6 MONTHS
meet once/twice a month for maintenance

WHY THE NATIONAL DPP?

CUTS THE RISK OF TYPE 2 DIABETES BY MORE THAN HALF

COST & TIME EFFECTIVE

EVIDENCE-BASED WITH SPECIFIED CDC QUALITY STANDARDS

Program Goal

Minimum body weight loss 5% in 6 months over 1 year of maintenance (10 lbs. for a person that weighs 200 lbs)

SECONDARY APPROACHES^{1, 2}

Pharmacological agents, such as metformin, alpha-glucosidase inhibitors, orlistat, and thiazolidinediones have each been shown to decrease the onset of type 2 diabetes to various degrees.

Metformin has:

STRONGEST MEDICATION EVIDENCE BASE

LONG-TERM SAFETY FOR DIABETES PREVENTION

DOSE OF 850 MG, TWICE DAILY

Currently there is no FDA approval for metformin for the indication of diabetes prevention

Knowler et al. N Engl J Med 2002;346:393-403.
Kanat M, DeFronzo RA, Abdul-Ghani MA. Treatment of Prediabetes. World J Diabetes. 2015 Sep 25;6(12):1207-22.

LIFESTYLE CHANGE PROGRAM

In-person & online options

Both options are recognized by the CDC.

Emphasis on prevention, empowerment, and helping people help themselves
Same content, goals, and time commitment
Lifestyle coach motivates and supports individuals
Peer-to-peer camaraderie
Group support
Progress reports

Online programs

Patient flexibility and simplified logistics
Complete the curriculum on your own schedule, within each week
Web and/or mobile enabled metrics and dashboards

COVERAGE & COST

Coverage for diabetes prevention varies and continues to grow through employee benefits and private and public insurance plans.

Typical patient out-of-pocket cost for the 12 month National DPP if no insurance coverage:

REFERRAL & ENROLLMENT

LOCATING & SELECTING A PROGRAM

Locating a lifestyle change program

Locate a CDC-recognized lifestyle change program in your community by using FIND A PROGRAM to identify in-person or online options.

We recommend that you become familiar with the programs so you can discuss options with patients and agree on an approach that best meets their needs.

REFERRING A PATIENT

A formal referral from the physician is a recommended best practice.

The program administrator or coach typically reaches out to the patient and shares program details, which in turn increases the likelihood of enrollment.

We encourage contacting programs in your area to better understand their recommended approach to referrals.

PROGRAM FOLLOW-UP

Plan a 3 or 6 month follow-up with patients to assess progress towards their weight loss goals and to address barriers to weight loss and a healthy lifestyle.

Program administrators may automatically send, or clinicians can request reports of participant progress to referring clinicians after the eighth and 16th group session.

Program participants complete periodic self-evaluations that referring clinicians can request directly from patients. You can also contact the program and request to receive information about your patient’s participation.

Monitor your patient’s fasting glucose or A1C every 6-12 months.

ACCESS TOOLKIT

JOIN IN THIS NATIONAL EFFORT

As a health care professional, you play an important part in preventing type 2 diabetes.
The AMA and CDC urge you to screen, test, and act today.

Select and download individual toolkit assets

You can help prevent type 2 diabetes

To help prevent type 2 diabetes, the Centers for Disease Control and Prevention (CDC) and the American Medical Association have created a toolkit that health care teams can use as a guide to screen, test and act today by referring patients to in-person or online diabetes prevention programs.

The AMA and CDC urge you to:

patients for prediabetes using the CDC Prediabetes Screening Test (or the American Diabetes Association Diabetes Risk Test)

patients for prediabetes using one of three blood tests

to help prevent diabetes by referring patients with prediabetes to a diabetes prevention program

See how a practice like yours is screening,
testing and acting today to prevent diabetes.

“I believe that physicians, nurse practitioners and physician assistants really need to send their patients so that they can benefit from this [the diabetes prevention program].”

Miguel Faña, MD
Fana Medical Group

“This partnership with the community and having that resource outside our four walls really does expand our care team.”

Jeanine Rosner, RN
Director, clinical projects, Park Nicollet

PREVALENCE & BURDEN

IMPACT OF PREDIABETES

Prediabetes is a reversible condition.

WHY ACT NOW?

PROGRESSION FROM PREDIABETES TO DIABETES

COST OF DIAGNOSED DIABETES¹

PATIENT IDENTIFICATION

PREDIABETES TESTING¹

RISK ASSESSMENT CRITERIA & FREQUENCY¹

AGE & BMI

RISK ASSESSMENT CRITERIA & FREQUENCY (continued)¹

TREATMENT

RANDOMIZED CONTROLLED TRIAL RESULTS¹

RANDOMIZED CONTROLLED TRIAL IMPACT

DPP clinical impact:

NATIONAL DPP

WHY THE NATIONAL DPP?

SECONDARY APPROACHES^{1, 2}

LIFESTYLE CHANGE PROGRAM

COVERAGE & COST

REFERRAL & ENROLLMENT

LOCATING & SELECTING A PROGRAM

REFERRING A PATIENT

PROGRAM FOLLOW-UP

ACCESS TOOLKIT

JOIN IN THIS NATIONAL EFFORT

You can help prevent type 2 diabetes

The AMA and CDC urge you to:

See how a practice like yours is screening,
testing and acting today to prevent diabetes.

Join the initiative to help prevent type 2 diabetes!

Learn how the AMA and CDC are preventing diabetes

PREVALENCE & BURDEN

IMPACT OF PREDIABETES

Prediabetes is a reversible condition.

WHY ACT NOW?

PROGRESSION FROM PREDIABETES TO DIABETES

COST OF DIAGNOSED DIABETES1

PATIENT IDENTIFICATION

PREDIABETES TESTING1

RISK ASSESSMENT CRITERIA & FREQUENCY1

AGE & BMI

RISK ASSESSMENT CRITERIA & FREQUENCY (continued)1

TREATMENT

RANDOMIZED CONTROLLED TRIAL RESULTS1

RANDOMIZED CONTROLLED TRIAL IMPACT

DPP clinical impact:

NATIONAL DPP

WHY THE NATIONAL DPP?

SECONDARY APPROACHES1, 2

LIFESTYLE CHANGE PROGRAM

COVERAGE & COST

REFERRAL & ENROLLMENT

LOCATING & SELECTING A PROGRAM

REFERRING A PATIENT

PROGRAM FOLLOW-UP

ACCESS TOOLKIT

JOIN IN THIS NATIONAL EFFORT

You can help prevent type 2 diabetes

The AMA and CDC urge you to:

See how a practice like yours is screening,testing and acting today to prevent diabetes.

Join the initiative to help prevent type 2 diabetes!

Learn how the AMA and CDC are preventing diabetes

COST OF DIAGNOSED DIABETES¹

PREDIABETES TESTING¹

RISK ASSESSMENT CRITERIA & FREQUENCY¹

RISK ASSESSMENT CRITERIA & FREQUENCY (continued)¹

RANDOMIZED CONTROLLED TRIAL RESULTS¹

SECONDARY APPROACHES^{1, 2}

See how a practice like yours is screening,
testing and acting today to prevent diabetes.