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Diabetes Discoveries & Practice Blog

When Should Patients with Prediabetes Be Referred to an Evidence-based Lifestyle Change Program?

Health care professional working with patient

Health care professionals can play a critical role in preventing type 2 diabetes by screening their patients for prediabetes.

More than 88 million American adults are estimated to be living with prediabetes, and more than 84% of them don’t even know that they have it. This is why it’s important for health care professionals to screen patients for prediabetes, especially if they have any of the diabetes risk factors. Data show that people who have prediabetes have up to a 50% chance of developing type 2 diabetes over the next 5 to 10 years.

Health care professionals who screen patients for prediabetes can let them know that there’s power in a prediabetes diagnosis—and that it is possible to prevent type 2 diabetes and even reverse prediabetes. “Once people are made aware of their condition, they are much more likely to make the necessary lifestyle changes to prevent it from progressing to type 2 diabetes,” says Dr. Christopher S. Holliday, director of the Division of Diabetes Translation at the Centers for Disease Control and Prevention (CDC).

This National Diabetes Month, we’re sharing the message that taking small steps can make a big difference when it comes to managing prediabetes. You can use our toolkit with a flyer and social media messages to help spread the word, and below are some tips for working with patients to manage prediabetes and prevent type 2 diabetes.

  1. Know the risk factors. You should test patients for prediabetes if they have overweight or obesity and one or more other risk factors for diabetes, or if their parents, siblings, or children have type 2 diabetes. And even if they don’t have risk factors, patients should start getting tested once they reach age 45.
  2. Screen and test your patients for prediabetes. CDC recommends that health care professionals employ a two-step process to screen and test patients for prediabetes. Step #1 involves having your patient take a simple pen-and-paper or online Prediabetes Risk Test. If the patient scores 5 or higher on the Prediabetes Risk Test, the next step includes giving your patient a blood glucose test to confirm their risk. There are three recommended blood testing methods to identify or diagnose prediabetes: A1C; fasting plasma glucose; and a 2-hour, post 75-gram oral glucose tolerance test. 
  3. Encourage patients that small changes can make a big difference. If your patients have prediabetes and overweight, losing 5-7% of their body weight by following healthy eating and drinking habits and increasing physical activity can reduce their type 2 diabetes risk by more than 50%. However, losing weight can be difficult, so encouraging patients to try small amounts of physical activity they like may help them manage their diabetes. “When it comes to physical activity, the best activity is the one that people are most likely to maintain. I encourage people with prediabetes to find ways to get moving that they actually enjoy,” says Dr. Holliday.
  4. Refer patients at high-risk to an evidence-based lifestyle change program. We know from research that participating in a year-long structured lifestyle change program, like the National Diabetes Prevention Program (National DPP) lifestyle change program, can reduce the risk of developing type 2 diabetes by 58% in adults at high risk for the disease. In fact, people at risk for type 2 diabetes may be more likely to consider enrolling in a program if their health care professional recommends it.

Below, Dr. Holliday shares more information about the National DPP, including how it works, who is eligible, and how to refer patients to the program.

Q: What should providers expect when they consider the National DPP lifestyle change program for their patients? How has it been successful?

A: The National DPP is a partnership of public and private organizations working to build a nationwide delivery system for a lifestyle change program proven to prevent or delay the onset of type 2 diabetes in adults with prediabetes. The National DPP has four key pillars: 1) a trained workforce of lifestyle coaches; 2) national quality standards supported by CDC’s Diabetes Prevention Recognition Program; 3) a network of more than 2,000 program delivery organizations sustained through coverage by public and private payers; and 4) patient referral and engagement.

At the core of the National DPP is a structured, evidence-based lifestyle change program. The program is founded on the science of the NIH’s Diabetes Prevention Program research trial and subsequent translation studies that showed that making modest behavior changes helped adults with prediabetes lose 5-7% of their body weight and reduce their risk of developing type 2 diabetes by 58% (71% for people over 60 years old). The program is interactive, group-based, and uses a CDC-approved curriculum that builds peer support and focuses on behavior change through healthy eating, increasing physical activity, and managing stress.

To date, more than half a million people at high risk for type 2 diabetes have enrolled in the National DPP lifestyle change program nationwide. Participants who completed the program achieved an average weight loss of 5.4%.

Q: Can my patients access the National DPP lifestyle change program virtually?

A: Yes, the National DPP lifestyle change program is accessible in-person, online, and through combinations of these different delivery modes. Online programs follow a CDC-approved curriculum and are held to the same standards as in-person programs. They also use a trained lifestyle coach, either in a group format or one-on-one. “An online program is a great option for those who may find it difficult to attend regular in-person sessions or when local in-person programs are unavailable,” notes Dr. Holliday.

It’s important to note that while patients with Medicare may be eligible to enroll at no cost in the Medicare Diabetes Prevention Program (MDPP), which is part of the National DPP, the MDPP traditionally is not available online. However, the Centers for Medicare & Medicaid Services recently issued flexibilities(PDF, 56 KB) during the COVID-19 pandemic to make it easier for eligible Medicare beneficiaries to participate in the program.

Q: Who is eligible to participate in the National DPP?

A: Patients who are eligible to join based on the requirements below should be referred to a CDC-recognized organization offering the National DPP lifestyle change program:

  • Be 18 years of age or older.
  • Have a body mass index (BMI) of ≥25 kg/m2 (≥23 kg/m2 if Asian American).
  • Meet one of the following criteria:
    • A blood test result meeting one of the following specifications:
      • Fasting glucose of 100 to 125 mg/dl
      • Plasma glucose of 140 to 199 mg/dl measured 2 hours after a 75-gram glucose load
      • A1C of 5.7 to 6.4
    • Clinically diagnosed gestational diabetes mellitus during a previous pregnancy.
    • A positive screening for prediabetes based on the Prediabetes Risk Test.
  • Not have a previous diagnosis of type 1 or type 2 diabetes prior to enrolling or be pregnant at the time they join the program.

Q: How do I refer patients to the National DPP lifestyle change program?

A: A list of CDC-recognized organizations offering the program in-person, online, or via distance learning can be found on the National DPP Find a Program webpage. A patient referral form(PDF, 43 KB) can be used to help with enrolling. Many health insurance plans cover the program, and patients can check with their health insurance company to discuss coverage. Visit the National DPP Customer Service Center for additional information and resources about the National DPP.

Patients with Medicare may be eligible to enroll in the MDPP at no cost. Information on Medicare beneficiary eligibility is available from the Centers for Medicare & Medicaid Services(PDF, 921 KB) . Providers can also access the MDPP Supplier Map or view a list of current MDPP suppliers and their locations and contact information.

How do you screen for and manage prediabetes with your patients? Tell us below in the comments.

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