Type 2 diabetes (T2D) is an urgent public health priority; Greater than 30 million adults in the United States have diabetes and as many as one-third by 2050. Nearly 85 million (one in three) have prediabetes, where the risk of developing T2D is 5-10% per year without intervention. Among overweight adults with prediabetes, efficacy studies demonstrate that intensive 52-week lifestyle interventions (“Diabetes Prevention Programs”, or DPP) reduce incident T2D by over 50% with reasonable maintenance over ten year follow-up. Translating these programs that support intensive lifestyle interventions to ‘real-world’ settings, such as primary care clinics, work organizations, churches, and schools, remains a challenge. In 2010, the Affordable Care Act created the National Diabetes Prevention Program, a public-private initiative, to promote the dissemination the DPP and to support community uptake at a large scale. Despite the clarity of evidence and broad support, there have been few studies that evaluate the implementation of large-scale translational prevention programs, and those that exist are limited to specific populations.
‘Real-world’ DPP models vary by eligibility, setting, technology used for implementation, community resources, and innovative pragmatic approaches. Worldwide, systematic reviews of implementation of DPP in ‘real world’ settings found they effectively lower body weight and incident T2D. For example, effectiveness persists in programs designed to expand reach (such as lowering DPP intensity) and lower costs (such as using of non-medical personnel). In the U.S., implementation of large scale preventative programs have been limited to veteran health facilities, Native American communities, and YMCA centers. I am specifically interested in examining the large-scale effectiveness and implementation of community-based DPP in the general population in the United States, both by community partner (nonprofit, employee-based, private) and platform (in-person vs virtual).
Since Medicare will provide payments for DPP starting in 2018, understanding factors associated with uptake and effectiveness is a critical research priority. Results of such an analysis will have significant policy implications for efforts to reach the >55 million adults with prediabetes eligible for lifestyle programs in the U.S. The estimated health burden of prediabetes in the US was nearly 50 billion, while costs per DPP participate range from around 300-3,000 USD per participant. Simulation models suggest DPP could be cost neutral in just over a decade and prevent or delay nearly one million cases of diabetes in 25 years, producing a cost savings of 5.7 billion USD.