Expanding what works
Medicare Diabetes Prevention Program
December 1, 2017
Diabetes is one of the most common and costly chronic diseases in the U.S. Over 30 million adults (12 percent) have diabetes, and total medical costs and lost work and wages for people with diabetes totaled $245 billion in 2012. Another 84 million adults (34 percent) have prediabetes, putting them at risk for developing type 2 diabetes. Prediabetes is a serious health condition in which blood sugar levels are higher than normal, but not high enough to be considered type 2 diabetes.
Diabetes progresses over time and can lead to serious health complications, including heart disease, stroke, blindness, kidney failure, amputations and early death. However, people with diabetes who successfully manage their disease can avoid these health complications.
The number of people with diabetes in the U.S. may increase to nearly 55 million by 2030, with total annual medical and non-medical costs reaching over $622 billion.
Population-based efforts like the National Diabetes Prevention Program (National DPP), and most recently the Medicare Diabetes Prevention Program, were created in response to the increasing toll of type 2 diabetes. These programs expand delivery of and coverage for programs aimed at reducing the burden of diabetes. The State of Alaska Diabetes Prevention and Control Program supports national efforts by increasing awareness of and promoting screening for prediabetes, and increasing referrals and access to local DPPs.
In 2009, the Centers for Disease Control and Prevention (CDC) established the National Diabetes Prevention Program to offer programs proven to prevent type 2 diabetes in communities nationwide. The National DPP grew out of research studies that showed a structured year-long lifestyle change program focused on weight loss could dramatically reduce the risk of type 2 diabetes. Modest weight loss of 5 percent to 7 percent through dietary changes and increased physical activity was more effective than medication alone at reducing this risk (58 percent versus 31 percent, respectively). The National DPP has grown to nearly 1,400 locations offering CDC-approved programs nationwide, including five in Alaska. Alaskans also have access to a free online DPP called Turnaround Health.
In 2016, the Centers for Medicare and Medicaid Services announced that the National Diabetes Prevention Program met the criteria for Medicare coverage because it saved costs and improved patient care among Medicare beneficiaries. As a result, more Medicare beneficiaries will be able to access Diabetes Prevention Program services as a covered benefit, starting in April 2018.
Like the National DPP, the Medicare Diabetes Prevention Program (MDPP) is a structured year-long intervention with the goal of preventing type 2 diabetes in people with prediabetes. The Medicare Diabetes Prevention Program consists of at least 16 core sessions during the first six months of the program, followed by monthly core maintenance sessions during the second six months. Another two years of ongoing maintenance sessions are covered if a minimum 5 percent weight loss is maintained. The in-person group sessions are led by a trained coach who offers strategies for healthier eating, increased physical activity, stress management and weight control.
Medicare beneficiaries are eligible for MDPP services if they have Medicare Part B insurance, a Body Mass Index of at least 25 (23 if Asian), a blood test that indicates prediabetes, and no prior diagnosis of type 1 or type 2 diabetes or end-stage renal disease. Organizations or individuals who plan to become an MDPP supplier can begin enrolling on Jan. 1, 2018. More information about eligibility criteria and future policy changes is available at https://innovation.cms.gov/initiatives/medicare-diabetes-prevention-program/.
Diabetes will remain a major health crisis and public health challenge, despite medical advances and prevention efforts. However, national population-based programs like the MDPP that increase access to and coverage for diabetes prevention services will make significant strides toward improving the nation’s health.
National Diabetes Prevention Program: https://www.cdc.gov/diabetes/prevention/index.html
National Diabetes Prevention Programs in Alaska: http://dhss.alaska.gov/dph/Chronic/Pages/Diabetes/management.aspx
Prediabetes risk test: https://doihaveprediabetes.org/
National Diabetes Prevention Program: Working Together to Prevent Type 2 Diabetes. CDC infographic, updated September 13, 2017. https://www.cdc.gov/diabetes/library/socialmedia/infographics.html
State of Alaska Diabetes Prevention and Control Program webpage: http://dhss.alaska.gov/dph/Chronic/Pages/Diabetes/default.aspx
Medicare Diabetes Prevention Program: https://innovation.cms.gov/initiatives/medicare-diabetes-prevention-program/
Free online DPP, Turnaround Health, through the State of Alaska: http://dhss.alaska.gov/dph/Chronic/Documents/Diabetes/TurnaroundHealth_Flyer.pdf
State of Alaska diabetes listserv: http://list.state.ak.us/mailman/listinfo/akdiabetes
Chung Nim Ha, MPH, is the Diabetes Prevention and Control Program Manager for the Section of Chronic Disease Prevention and Health Promotion, Alaska Department of Health and Social Services.