Diabetes Prevention Program

Marcelle Thurston MS, RD, CDEKelly McCracken RD, CDE

Colorado Department of Public Health and Environment

Goals for Today

• Define the impact of pre-diabetes in Colorado • Provide an overview of the Diabetes Prevention

Program (DPP)• Describe the national infrastructure in place for

DPP to be sustainable in individual states• Highlight the onsite Diabetes Prevention

Program at the Colorado Department of Public Health and Environment

• List potential roles of business coalitions

Impact of Prediabetes in Colorado

4

What is Pre-diabetes?

• A blood sugar level that is higher than normal but not high enough to be classified as diabetes

• Without lifestyle changes most people with pre-diabetes will develop type 2 diabetes within 6 years

• Risk is highest in overweight adults over the age of 45, have family history of diabetes or history of gestational diabetes

Obesity Trends* Among U.S. AdultsBRFSS, 1990

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Obesity Trends* Among U.S. AdultsBRFSS, 1991

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. AdultsBRFSS, 1992

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. AdultsBRFSS, 1993

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. AdultsBRFSS, 1994

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. AdultsBRFSS, 1995

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. AdultsBRFSS, 1996

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. AdultsBRFSS, 1997

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends* Among U.S. AdultsBRFSS, 1998

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends* Among U.S. AdultsBRFSS, 1999

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends* Among U.S. AdultsBRFSS, 2000

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends* Among U.S. AdultsBRFSS, 2001

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 2002

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Obesity Trends* Among U.S. AdultsBRFSS, 2003

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Obesity Trends* Among U.S. AdultsBRFSS, 2004

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Obesity Trends* Among U.S. AdultsBRFSS, 2005

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. AdultsBRFSS, 2006

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. AdultsBRFSS, 2007

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. AdultsBRFSS, 2008

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. AdultsBRFSS, 2009

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. AdultsBRFSS, 2010

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

26 million with Diabetes

79 millionwith Prediabetes

Value of Investing in PreventionDelaying or preventing diabetes impacts:

Presenteeism Productivity Staff retention

Mitigates higher risk pool: Avg. medical costs for a person with diabetes are

nearly twice those of a person without diabetes Costs are more than four-fold for a person with

diabetes-related complications compared to a person without diabetes

No diabetes Prediabetes Diabetes, no complications Diabetes, compliant w/ hypertension

Diabetes, compliant w/ CVD$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000

Total Progressive Cost for Diabetes($/per member per year; average for 2 large health plans; excludes Rx)

Overview of the Diabetes Prevention Program (DPP)

30

The Diabetes Prevention Program (DPP)

• Based on NIH and CDC clinical trials• 5% - 7% weight loss & increased physical

activity to 150 minutes a week reduced risk of developing type 2 diabetes by 58%

• 10-year follow up study showed reduced diabetes incidence of 34% in the lifestyle group

• Translated into 16-week group based program

Cardiovascular risk factors also improved with the DPP

• Blood pressure significantly lowered

• Cholesterol levels significantly improved

• At 3 year follow-up the use of meds for both blood pressure and cholesterol were lowered

DPP. Diabetes Care 28:888–894, 2005

Journey of the Diabetes Prevention Program

Clinical research trials

funded throughNIH and CDC

DPP was adapted for

groups based classes

YUSA was an early adopter of the DPP

(YDPP)

UnitedHealthGroupwas an early adopter

of the DPP

(DPCA)

To date the YDPP is in 39 states

Participating YMCA’s are reimbursed by

United

CDC developed the Diabetes

Prevention Recognition

Program

The Diabetes and Technical

Assistance Center developed a

training for the curriculum

CDC , through their state-based Diabetes

Prevention and Control Programs, are promoting the

DPP

Colorado’s DPP Advisory Group

CDC

How DPP differs from other programs

• Evidence based• Low cost• Pay for performance model• Decreases risk of other obesity related

diseases• National infrastructure to assure fidelity

The look of DPP

• 16-week group based classes• Led by a skilled facilitator• Topics include healthy eating, physical activity, goal

setting• Offered at YMCA and community based organizations

in several counties• Can be offered onsite for employees• UnitedHealthcare covers DPP in CO for fully-insured

members• $300-$400 per participant; based on outcomes

Role of Business Coalitions• Educate employers about pre-diabetes and Diabetes

Prevention Programs in the area1-800-DIABETES

• Support employers in identifying:– % of employees at risk– communication strategies about prediabetes and DPP– community partners

• Align shared priorities and goals • Create tip sheet for how to negotiate with health

plans to include the Diabetes Prevention Program

38

For more information

CDC Diabetes Prevention and Recognition Program

http://www.cdc.gov/diabetes/prevention/recognition/index.htm

Kelly McCrackenkelly.mccracken@state.co.us

303/692.2512

Marcelle Thurstonmarcelle.thurston@state.co.us

303/692.2519