Making Diabetes Prevention a Reality: The National Diabetes Prevention Program Appalachian Diabetes Coalitions Celebrating Success Conference October 7, 2016

Our Public Health Challenge… 29 million Americans have diabetes 86 million American adults have prediabetes 9 out of 10 adults with prediabetes don’t know they have it Source: Centers for Disease Control and Prevention. National diabetes statistics report: estimates of diabetes and its burden in the United States, 2014. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, 2014.

Current Projection of Cases of Diabetes in the United States by 2030 millions Source: Zhang X, Gregg EW, Williamson DF, et al. A1C level and future risk of diabetes: a systematic review. Diabetes Care 2010;33(7):1665–73.

National Diabetes Prevention Program largest national effort to mobilize and bring effective type 2 diabetes prevention programs to communities across the U.S.  

Diabetes Prevention 101 – A Brief History (Type 2 Diabetes Prevention Evidence Summary) Randomized Clinical Control Trial, DPP (2002): The 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. Subsequent Translation Studies Various Evidence-based Recommendations USPSTF Obesity Intensive Behavioral Counseling July 2012 Community Guide Review - Combined Diet and Physical Activity Promotion Programs to Prevent Type 2 Diabetes Among People at Increased Risk July 2014 USPSTF CVD Risk Reduction Intensive Behavioral Counseling August 2014 USPSTF Type 2 Diabetes and Abnormal Glucose Screening October 2015 Community Guide Review – Interventions Engaging CHWs August 2016

Albright A, Gregg EW. Am J Prev Med. 2013;44(4S4):S346-S351. National Center for Chronic Disease Prevention and Health Promotion Division of Diabetes Translation www.cdc.gov/diabetes

1212 1305 1422 Scaling & Sustaining National DPP CDC Cooperative Agreement Investments 1212 Funded national organizations to increase # of CDC-recognized organizations offering lifestyle change programs via multi-state networks and expand coverage through relationships with employers and insurers that lead to benefit coverage and reimbursement for delivery organizations 1305 Funded all 50 states & D.C. to raise awareness of prediabetes, increase referrals to CDC-recognized programs, and work with State Employee Benefit Plans and Medicaid to support coverage 1422 Funded 17 states and 4 cities to expand on work started by 1212 and 1305 and enroll vulnerable, high-risk populations in the program

Status: Scaling and Sustaining National DPP Over 1000 CDC-recognized programs across 49 states and DC >900 in-person programs 25 virtual programs 74 combination in-person and virtual programs Serving more than 88,000 eligible participants Average weight loss for participants who attend at least 4 sessions over the yearlong program is 4.6% Over 65 commercial health plans providing coverage in select markets About 3 million state employees covered in 11 states Source: CDC DPRP program data as of 02/29/2016.

Expansion of National DPP for Medicare Beneficiaries Section 1115A of the Social Security Act established CMMI to test innovative payment techniques for service delivery models Secretary of Health may expand the duration and scope of successful models Reduce spending w/o reducing quality or improve quality w/o increasing cost Chief Actuary of CMS certifies the expansion would reduce net program spending Would not deny or limit coverage for applicable individuals Y DPP model tested and found $2,650 savings/enrollee over 15 mos. CMS Proposed Rule (phase 1) published July 2016; Phase 2 in 2017, benefit available on or about January 2018

Medicaid Medicaid Demonstration Project Goal: Test the feasibility/effectiveness of various models to obtain Medicaid coverage for the National DPP 2 states (OR, MD) selected to work with Medicaid Managed Care Organizations to develop and implement a coverage model Successful models will be translated for use by other states Medicaid Toolkit – available early 2017  Montana and Minnesota already have Medicaid coverage for the National DPP Seven states are participating in a CMS Medicaid Affinity Group to explore coverage for the National DPP, including WV

Diabetes Prevention Recognition Program (DPRP)- Three Main Goals Assure program quality and fidelity to scientific evidence 2002 DPP research trial & follow-up efficacy studies Community translation of the studies Evidence-based, yearlong CDC-approved curricula Maintain national registry of organizations recognized for delivering effective programs Provide technical assistance to achieve and maintain full CDC recognition 1111

DPRP - Application Process READ – Standards Document on CDC DPRP website http://www.cdc.gov/diabetes/prevention/pdf/dprp-standards.pdf Complete – Capacity Assessment posted to the CDC DPRP Website (Appendix A of the standards) Does my organization have the capacity to implement and sustain the program long-term without government grant funds? Does my organization have a data collection system? Does my organization have the capacity to develop or implement data collection system? Does my organization have the resources to train Lifestyle Coaches? 1212

DPRP - Recognition Status Pending recognition - granted when organization agrees to: use an evidence based curriculum that meets duration, intensity, and reporting requirements described in the DPRP Standards provide data reports to CDC every 12 months be evaluated by CDC DPRP 24 months after first class offer first class within 6 months of receiving pending recognition (i.e., the “effective date” on an approved application) Pending and Full Recognition Organizations submit data every 12 months to CDC DPRP Technical Assistance provided by CDC Full Recognition Evaluated by CDC based on 2 sets of 12-month data Recognition status is evaluated every 24 months thereafter 13

What participant data will be reported to CDC? Participant’s Prediabetes Determination: (GLUCTEST, GDM or CDC Prediabetes Screening Test) Note: these will be Y/N fields – specific values not reported Demographics: Age, Ethnicity, Race, Sex, State Physical characteristics: Height, Weight (height and weight used to determine BMI) Session data: Weight, Minutes of Physical Activity 14

Diabetes Prevention Recognition Program Registry Program contact information included on CDC web registry https://nccd.cdc.gov/DDT_DPRP/Programs.aspx 13 15

Current Map of National DPP Recognized Organizations and Classes

Diabetes Prevention Recognition Program DPRP Standards Revision Assessing/Enhancing Systems for DPRP Data Collection and Analysis

Intervention Intensity Average % Weight Loss from First to Last Session (numbers current as of 4/1/2016)   23

Intervention Duration Average % Weight Loss from First to Last Session (numbers current as of 4/1/2016) 24

Intervention Intensity/Duration Average % Weight Loss from First to Last Session (numbers current as of 4/1/2016) 25

Ways to Facilitate Participant Success Not transitioning immediately from weekly to monthly classes at the half way point; move to bi-weekly classes, then shift to monthly Starting classes at the start of the new year or start of the school year Personal interaction between classes, use of social media or text messaging reminders Physician referrals Incentives when a participant meets a program milestone Use successful previous participants as speakers, participant testimonials Provide support for transportation and childcare

Training, Assistance, and Dissemination Customer Service Center Coming in 2017! New Tools/Resources Redesigned Website

National DPP Website Redesign http://www. cdc

CDC’s New PreventT2 English and Spanish Curriculum http://www.cdc.gov/diabetes/prevention/lifestyle-program/curriculum.html

National DPP/PreventT2 Promotional Materials http://www.cdc.gov/diabetes/prevention/lifestyle-program/resources_rrp.html

Testimonials from Program Providers Get involved… Tell your story !! http://www.cdc.gov/diabetes/prevention/lifestyle-program/testimonials_providers.html

Award-Winning Ad Council Campaign

DoIHavePrediabetes.org WEBSITE https://doihaveprediabetes.org/ Learn how you can reverse prediabetes and prevent type 2 diabetes.

Prevent Diabetes STAT (Screen, Test, Act Today!) AMA/CDC call-to-action launched on March 12, 2015 Website offers resources for health care professionals, patients, and employers/insurers on preventing type 2 diabetes www.preventdiabetesstat.org 32

AMA/CDC Health Care Provider Toolkit http://www.ama-assn.org/sub/prevent-diabetes-stat/toolkit.html 33