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

2. 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, Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, 2014.

3. 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.

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

5. 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

6. 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

7. 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

8. 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.

9. 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

10. 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

11. 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

12. DPRP - Application Process
READ – Standards Document on CDC DPRP website
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

13. 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

14. 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

15. Diabetes Prevention Recognition Program Registry
Program contact information included on CDC web registry 13 15

16. Current Map of National DPP Recognized Organizations and Classes

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

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

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

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

21. 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

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

23. National DPP Website Redesign http://www. cdc

24. CDC’s New PreventT2 English and Spanish Curriculum

25. National DPP/PreventT2 Promotional Materials

26. Testimonials from Program Providers
Get involved…
Tell your
story !!

27. Award-Winning Ad Council Campaign

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

29. 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 32

30. AMA/CDC Health Care Provider Toolkit 33