The National DPP → Evidence
Research studies and evaluations have repeatedly shown that interventions such as the National DPP lifestyle change program improve health outcomes and are cost-effective or cost-saving.
Diabetes Prevention Program (DPP) Clinical Trial
The Diabetes Prevention Program was a randomized clinical trial funded by the National Institutes of Health (NIH) and supported by the CDC that began in 1996. A total of 1,079 participants experienced a lifestyle intervention that resulted in a 58% reduction in the rate of diabetes. The goals of the intervention were a 7% reduction in weight and 150 minutes a week of physical activity. It featured individual coaching, a 16-session core curriculum, supervised physical activity, and other supports.
10 and 15-year follow up studies were also completed. The 15-year follow up study substantiated that diabetes incidence was reduced by 27% in the group that experienced the intervention, and that “cumulative diabetes incidences” was 55% as compared to 62% in those who had not had an intervention.
For more information on the Diabetes Prevention Program clinical trial, click here.
The 10-year follow up study can be found here.
The 15-year follow up study can be found here.
Diabetes Education & Prevention with a Lifestyle Intervention Offered at the YMCA (DEPLOY) Pilot Study
In 2008, the DEPLOY Pilot Study examined the feasibility of offering the DPP clinical trial intervention in community settings, using a lower-cost group-based model. Trained YMCA wellness instructors facilitated the group sessions. Participants in the relatively small cohort successfully lost 6% of their body weight.
For more information on the YMCA pilot study, click here.
The Center for Medicare & Medicaid Innovation (CMMI) Health Care Innovation Awards – YMCA of the USA (Y-USA) Implementation
Many additional studies have been conducted on variations of the DPP intervention. One recent evaluation conducted by RTI International assessed a Y-USA implementation of the National DPP lifestyle change program. The Y-USA received an $11M CMS Health Care Innovation Award to implement and evaluate the program with Medicare beneficiaries in 17 YMCA locations. The goals of the intervention were to support participants in losing at least 5% of their body weight and exercising 150 minutes per week. The participants received group coaching. RTI found that in the first five quarters of the program, savings amounted to $2,636 per participant. Through the first 11 quarters, those attending at least one core session lost 3.8% of their body weight, and those attending at least four core sessions lost 4.5% of their body weight.
For more information on the CMMI innovation award implementation through Y-USA, click here.
Centers for Medicare and Medicaid Services (CMS) Office of the Actuary (OACT) Certification Report
In March 2016, the CMS Office of the Actuary (OACT) released a certification report for expansion of the Y-USA National DPP lifestyle change program. It reviewed results from the first two years of the Y-USA National DPP lifestyle change program implementation (referenced above), the original DPP clinical trial, and a subset of lifestyle change programs recognized by the CDC. The report confirmed the results and certified that an expansion of DPP in the Medicare population would reduce (or not increase) net-Medicare spending.
For more information on the CMS OACT report, click here.
Community Preventive Services Task Force
The Community Preventive Services Task Force conducted a review of 53 studies (from January 1991 through February 2015) based on 66 combined diet and physical activity promotion programs. The Task Force concluded that such interventions are cost-effective, and recommended diet and physical activity promotion programs for individuals at increased risk for developing type 2 diabetes. It made this recommendation based on “strong evidence of effectiveness in reducing new-onset diabetes.”
For more information on the Community Preventive Services Task Force, click here.
Institute for Clinical and Economic Review (ICER)
In May 2016, the Institute for Clinical and Economic Review (ICER) released a Draft Evidence Report, “Diabetes Prevention Programs: Effectiveness and Value.” The report was subsequently finalized. The report assessed 10 U.S. National DPP lifestyle change programs with full or pending recognition from the CDC’s Diabetes Prevention Recognition Program. The report concluded that the programs (using in-person group coaching or an online format with a human coach) provided “an incremental or better” net health benefit. It also concluded that online programs with fully automated (not human) coaching provided “comparable or better” net health benefit versus standard care.
For more information on ICER, click here.
The 6|18 Initiative Evidence Summary: Control and Prevent Diabetes
The 6|18 initiative targets 6 common and costly health conditions, including diabetes, using 18 proven interventions. The diabetes prevention related interventions proposed in the 6|18 initiative include: (1) expanding access to the National DPP lifestyle change program, and (2) promoting screening for abnormal blood glucose in those who are overweight or obese as part of a cardiovascular risk assessment. The CDC authored an evidence summary in support of these proposed interventions that includes several studies supporting the use of the National DPP lifestyle change program. For example, a systematic review of 53 studies by The Community Guide found that participation in a combined diet and physical activity promotion program by individuals with an increased risk of type 2 diabetes decreased the proportion who developed type 2 diabetes by 11 percentage points.
For more information on the 6|18 initiative, click here.
Center for Medicare & Medicaid Innovation (CMMI) Medicaid Incentives for the Prevention of Chronic Diseases (MIPCD) Grants
To date there has been limited published data and analysis on the National DPP lifestyle change program in Medicaid populations. Minnesota, Montana, Nevada and New York have received Medicaid Incentives for the Prevention of Chronic Diseases (MIPCD) grants where a portion of the grant dollars funded incentives for National DPP lifestyle change program participants. Final evaluations of these programs may surface additional information about cost-effectiveness and health outcomes as it pertains to the National DPP lifestyle change program in Medicaid.
Oregon Health & Science University (OHSU) Center for Evidence-based Policy
The Center for Evidence-based Policy at OHSU produced a report in October 2017 discussing the long-term health effects of dietary and physical activity changes such as those used in the diabetes prevention program. This report reviews the long-term effects of combined diet and physical activity focused lifestyle interventions on individuals with prediabetes or at high risk for diabetes. The lifestyle interventions evaluated in this report either used the protocol from the diet and physical activity arm of the original Diabetes Prevention Program (DPP) randomized controlled trial (RCT) (i.e., DPP intervention), or used a similar lifestyle intervention to the original DPP RCT diet and physical activity protocol (i.e., DPP-like intervention). This report also includes an evaluation of the long-term effectiveness of variations in program delivery or population subgroups for DPP or DPP-like interventions.
For a copy of this report click here.
The United States Preventive Services Task Force (USPSTF) is an independent panel of experts that publishes recommendations for evidence-based clinical preventive services. The Affordable Care Act requires a subset of health plans to cover items and services with a grade A or B USPSTF recommendation without cost-sharing for the relevant member. The counseling requirements for abnormal blood glucose, healthful diet and physical activity, gestational diabetes, and obesity can be met through coverage of the National DPP lifestyle change program. These recommendations will bring additional attention to prediabetes and may create momentum around the development of prediabetes measures.
Benefits Related to CVD Risk Reduction
Several studies have found that lifestyle intervention programs can reduce the risk of cardiovascular disease. For example, a 2005 randomized clinical trial found that an intensive lifestyle intervention designed to achieve and maintain a 7% weight loss and 150 minutes of exercise per week decreased the incidence of metabolic syndrome (i.e., increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels that occur together) by 41%.
A 2013 study of the long-term effects of diabetes prevention programs found that after ten years the intensive lifestyle intervention achieved a comparable positive long-term effect on cardiovascular disease risk factors as was seen in metformin and placebo groups. A 23-year study of people with impaired glucose tolerance concluded that the cumulative incidence of cardiovascular disease mortality decreased from 19.6% in the control group to 11.9% in the group with a lifestyle intervention.
A review of 44 studies concluded that diabetes prevention lifestyle modification programs achieved clinically meaningful weight and cardiometabolic health improvements, and another review found that combined diet and physical activity programs lowered systolic and diastolic blood pressure and improved lipid levels.
Benefits Related to Weight Loss and Reduction of Sleep Apnea
Another benefit of the National DPP lifestyle change program is the reduction of sleep apnea. A study of obese adults with type 2 diabetes and obstructive sleep apnea found that over four years, intensive lifestyle intervention produced greater reductions in weight and sleep apnea than diabetes support and education only. An analysis of two systematic reviews and eight randomized control trials of overweight or obese individuals who had obstructive sleep apnea also found that intensive lifestyle interventions resulted in significant weight loss and reduction in sleep apnea severity. Similarly, a systematic review and meta-analysis of 12 controlled trials found that intensive lifestyle management can significantly reduce obesity indices and decrease the severity of sleep apnea.
Other Benefits on Health-Related Quality of Life, Mental Health, and Well-Being
The National DPP lifestyle change program can also improve general health, physical function, reduce bodily pain, and improve vitality scores on a health survey after three years. Similarly, another study concluded that weight loss because of the National DPP lifestyle change program was associated with improvements in measures of health-related quality of life. Finally, a study of a work place diabetes prevention lifestyle change program found improved metabolic and behavioral risk factors among employees with prediabetes.