the national diabetes prevention program updates 2014
DESCRIPTION
A presentation on National DPP training and program recognition.TRANSCRIPT
National Diabetes Prevention Program
Ann Albright, PhD, RDDirector, Division of Diabetes Translation
Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
Division of Diabetes Translation www.cdc.gov/diabetes
The findings and conclusions in this presentation are those of the author and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
29 million with Diabetes
86 millionwith Prediabetes
Centers for Disease Control and Prevention National Diabetes Statistics Report, 2014
www.cdc.gov/diabetes
County-level Estimates of Diagnosed Diabetes among Adults Aged ≥20 Years: United States 2004–2010
Percent0 - 6.5
6.6 - 8.0
8.1 - 9.4
9.5 - 11.1
> 11.2
Current Projections of Cases of Diabetes
in the United States by 2030
2007 2010 2015 2020 2025 20300
10
20
30
40
50
60
70
mill
ion
s
Economic Cost of Diabetes in US, 2012
Total economic costs, $245 b.
Institutional care $91b. Outpatient care $32 b.
Indirect cost, $69 b.Direct medical cost, $176 b.
Lost workdays, $5 b.Product. loss, $24 b.Disability $22 b.
Mortality, $18 b.
Medications and supplies $53 b.
ADA, Diabetes Care, 2013
Very High Risk
(A1c > 5.7%; IGT; GDM)
Moderate Risk
Low Risk
High Risk (FPG > 100);
Central Obesity; HTN, age
Risk Stratification Pyramid for Diabetes Prevention
10-year risk (%)
>30 %
>20 %
>10%
>0%
Prevalence (%)
~10 %
~25 %
~65%
Proportion of U.S. Adults Aged > 20 with Prediabetes
Who Are Aware of Their Risk Status
MMWR, 2013
Evidence for National Diabetes Prevention Program
• The DPP research study showed that structured lifestyle change program achieved modest weight loss of 5-7 percent and 150 min PA/wk reduced type 2 diabetes by 58% (71% in those over age 60) in those at high risk for type 2 diabetes– True for all participating ethnic groups and for both men and women– Blood pressure and lipids improved– 10-year f/u shows continued reduction in new cases of type 2 diabetes
• Translational studies demonstrate trained lay health workers are as effective in delivering the lifestyle change program as health professionals
• National DPP is 1/3 of the cost of DPP research study and demonstrates similar lifestyle change results
Cost Effectiveness
• Diabetes prevention lifestyle change programs have been shown to be cost effective and can be cost saving
• Influenced by target population, delivery format and personnel, time horizon
• Some modeled data from an insurer has shown a three year cumulative ROI of 3:1 when using a pay-for-performance approach
BASIC SCIENCE
EFFICACY
EFFECTIVENESS
EFFICIENCY
AVAILABILITY
DISTRIBUTION
Molecular/ physiological
Molecular/ physiological
Ideal settings
Ideal settings
Real world settings
Real world settings
Biggest effect on most people
Biggest effect on most people
SupplySupply
Diffusion of interventionsDiffusion of
interventions
Adapted from information in Sinclair JC, et al. N Engl J Med. 1981;305:489–494. and Detsky AS, et al. Ann Intern Med. 1990;113:147-154.
National Center for Chronic Disease Prevention and Health Promotion
Division of Diabetes Translation www.cdc.gov/diabetes
Albright A, Gregg EW. Am J Prev Med. 2013;44(4S4):S346-S351.
Increase Workforce
• Trained lifestyle coaches attached to delivery organization
• Lay coaches and health professional coaches can both effectively deliver the program
• Use organizations that train to a CDC-approved curriculum
• > 6800 coaches trained
Quality Assurance
CDC Recognition:• Assure program quality and fidelity to
scientific evidence• Maintain a registry of recognized
organizations• Provide technical assistance to programs to
assist staff in delivery and problem-solving to achieve and maintain recognition
• > 500 sites in recognition program
www.cdc.gov/diabetes/prevention/recognition
Getting Started: Diabetes Prevention Recognition
Program• CDC recognizes U.S. organizations with programs that are effective in helping participants achieve lifestyle changes that prevent type 2 diabetes among those at risk
• Achieve and maintain recognition by applying for and following the Diabetes Prevention Recognition Program Standards – Participating organizations voluntarily submit program data
to CDC
• Review Diabetes Prevention Recognition Program standards and operating procedures prior to submitting the application
http://www.cdc.gov/diabetes/prevention/recognition
Diabetes Prevention Recognition Program
www.cdc.gov/diabetes
Application rejected, TA offered
Perform capacity
assessment
Go to DPRP Web
page
CDC reviews
application
Submit session data
every six months
Read DPRP
Standards
Pending recognition status
CDC evaluates
program at 24 months
Review Curriculum
Recruit and begin lifestyle change class
Program is granted full recognition
status
Submitonline form
First session data to CDC
after six months
Recognition evaluated every 24 months
ApplicationReview/Initiate
Maintenance
www.cdc.gov/diabetes/prevention/recognition.htm
Pending recognition status if
not compliant
If using National
DPP Curriculum may consult DTTAC for training
Recognition Benefits
Quality Assurance associated with recognition can be influential to help you: • enroll participants • obtain health care provider referrals
Recognition may facilitate reimbursement from a growing number of insurers paying for the program
CDC provides technical assistance, including feedback on data submitted
There is no charge to become recognized by CDC
Recognition Benefits
Program contact information included on CDC web site
http://www.cdc.gov/diabetes/prevention/recognition/registry.htm
Recognition Benefits: Collective Impact
Recognized programs join the largest national effort, the National Diabetes Prevention Program,
to bring this effective lifestyle change program to communities
Deliver Program
• Link health care and community sectors• Effective business model for program
scalability and sustainability• Programs in 50 states and DC to date –
need many more• Exploring methods to deliver program
more widely• 5.8% wt. loss with > 4 first phase sessions
and > 1 second phase sessions (maintenance)
Current National Diabetes Prevention Program Sites
Copyright © 2005-2014 Zee Source. All rights reserved.
20
Source: Diabetes Prevention Recognition Program (CDC/National Diabetes Prevention Program)
Support Program Uptake
• 89% with no diagnosis and no symptoms requires aggressive awareness and testing efforts
• Engage multiple channels: employers, insurers, providers and directly to consumers
Summary
– Evidence for prevention through lifestyle change is strong
– Lifestyle change program is cost effective
– A coordinated approach, as provided by the National DPP, is critical to achieve scale
– Quality assurance and evaluation are part of National DPP
– Need to act now and think BIG