In observance of American Diabetes Month, health organizations like the American Diabetes Association (ADA) are raising awareness about diabetes prevention and the critical need for early intervention. One effective approach is the Diabetes Prevention Program (DPP), an ongoing initiative designed to help high-risk individuals avoid developing type 2 diabetes. Through structured education, peer support, and guidance from lifestyle coaches and health care providers, the DPP equips participants with the tools they need to create and maintain healthy habits that can last a lifetime.
Prediabetes: The Tipping Point to Type 2
According to the Centers for Disease Control and Prevention (CDC), approximately 37.3 million American adults live with diabetes, representing 11.3% of the U.S. population. Of these, about 8.5 million individuals are undiagnosed, meaning nearly 23% of people with diabetes are unaware of their condition. The prevalence of diabetes is highest among American Indians, Hispanic Americans, non-Hispanic Black Americans, and some Asian American and Pacific Islander groups. Prediabetes, where blood sugar levels are elevated but not yet high enough to be considered diabetes, is increasingly common and represents a significant health risk. It’s estimated that 96 million American adults—about one in three—have prediabetes, yet nearly 84% remain unaware.
Once referred to as impaired glucose tolerance, prediabetes signals a high risk of progression to type 2 diabetes if left unmanaged. Early detection and intervention can delay or prevent this progression, addressing a potential crisis in health care systems, patient outcomes, and economic impact.
To combat the prevalence of prediabetes, experts recommend identifying vulnerable populations and employing a quadruple aim approach, which focuses on improving population health, reducing costs for patients and providers, supporting health care staff well-being, and enhancing patient experience.
Diabetes Prevention Program (DPP) Overview
The DPP, first introduced in the late 1990s, combines individual provider visits, group support, and lifestyle modifications to help prevent prediabetes from advancing to type 2 diabetes. The program is highly adaptable, allowing health care facilities to tailor it based on their specific patient demographics and resources.
The program has been extensively studied since its inception, providing valuable insights into the long-term effectiveness of lifestyle interventions and metformin in preventing type 2 diabetes.
Initial Study Findings:
The original DPP study demonstrated that:
- Lifestyle Intervention: Participants who engaged in intensive lifestyle changes experienced a 58% reduction in the progression to type 2 diabetes. Notably, individuals aged 60 and older achieved a 71% reduction.
- Metformin Group: Those receiving metformin treatment saw a 31% reduction in diabetes progression, with the medication being particularly effective among younger participants and those with a higher body mass index (BMI).
Long-Term Outcomes:
The Diabetes Prevention Program Outcomes Study (DPPOS) has provided updated data on the long-term effects of these interventions:
- 10-Year Follow-Up: Participants in the lifestyle intervention group continued to have a 34% reduction in the development of type 2 diabetes compared to the placebo group. Those aged 60 and older maintained a 49% reduction.
- 22-Year Follow-Up: Over an average follow-up of 22 years, both lifestyle intervention and metformin treatment groups showed a persistent reduction in the risk of developing type 2 diabetes. The lifestyle intervention group maintained a significant reduction in diabetes incidence, underscoring the lasting benefits of early lifestyle changes.
These findings highlight the enduring impact of lifestyle modifications and metformin in reducing the risk of type 2 diabetes, emphasizing the importance of early intervention and sustaining healthy habits.
Today, DPPs have evolved to incorporate telehealth options, enabling participants to attend sessions remotely and reducing access barriers for those in rural or underserved areas. The program’s flexible format allows providers to implement the DPP at a lower cost and with greater accessibility, making it possible to support a wider range of patients in their efforts to prevent diabetes.
Key Success Factors for DPP
The DPP’s flexibility allows for creative adaptations, making it an effective and affordable solution for health care providers. Success factors include:
- Culturally Competent Coaches: Selecting coaches who are culturally humble, adaptable, and motivated enhances engagement among diverse populations.
- Incentives: Rewards like scales, pedometers, and grocery vouchers encourage consistent participation and help participants stay on track.
- Community Partnerships: Collaborations with local farms to provide fresh produce support participants’ health goals and foster community connections.
- Recognition: Social media shoutouts and certificates for program milestones boost motivation and reinforce accountability.
The Quadruple Aim Benefits
The DPP supports these four essential outcomes:
- Population Health: Patients reduce their risk for diabetes and improve overall health. Many also refer friends and family to the program, promoting diabetes prevention within their communities.
- Cost Reduction: Patients invested in their health are less likely to miss appointments or rely on emergency services, reducing health care costs.
- Health Care Team Well-Being: Providers gain confidence as they witness patient progress and gain insight from group discussions.
- Enhanced Patient Experience: Patients receive more face time with coaches, track progress, and celebrate achievements, fostering a sense of empowerment.
Implementing a Diabetes Prevention Program
Addressing the type 2 diabetes crisis requires early identification, open discussion, and proactive treatment. Experts recommend using prediabetes screenings for at-risk patients and making printed versions available in waiting areas. These screenings can help initiate a conversation with patients about their health risks and available treatment options. The value of the DPP lies in the investment it encourages patients to make in their own health.
To implement these programs, experts suggest starting with resources you already have. Existing health programs focused on healthier habits can serve as a foundation for introducing more intensive DPP elements. While committing to a full 12-month program may feel overwhelming, inviting patients to participate in a healthy cooking class, fitness group, or gardening workshop may be easier entry points. Lunch-and-learn sessions, seasonal activities, and monthly support groups also provide ways to ease into lifestyle changes.
Because managing health can take an emotional toll, especially for diabetes patients, coaches are essential to a program’s success. Rather than hiring a diabetes specialist, health care providers can leverage existing team members to serve as coaches. Coaches should be friendly, motivating, and supportive, fostering an environment that encourages patients to take an active role in their health.
Providers who have successfully implemented DPPs recommend choosing coaches who are culturally humble, flexible, intuitive, independent, passionate, consistent, and outgoing. Although the DPP encourages a team approach and regular check-ins to monitor patients’ progress; coaches who can balance individual needs with group dynamics are invaluable.
Incentives can also enhance engagement. Possible incentives that encourage healthy habits include scales, pedometers, exercise gear, food program support, transportation vouchers, and groceries. Although not required, providing small incentives for attending group meetings can increase motivation and create opportunities for collaboration.
For example, some programs partner with local farms to provide fresh produce, giving participants access to healthy foods that align with their health goals while also supporting local businesses. These collaborations can expand to include activities like cooking classes using fresh ingredients from local farms.
Recognizing participants’ progress is key. Social media shoutouts and certificates at key milestones, such as program midpoint and completion, foster motivation and a sense of accomplishment. The encouragement provided by coaches and peers cheering each other on has proven to be a powerful motivator.
An Investment for Life
Helping patients take charge of their health not only reduces costs but also lowers the likelihood of a future diabetes epidemic. By equipping patients with skills they can carry with them beyond the program, DPPs empower patients to make long-term health improvements. Reducing the need for specialist care, unscheduled visits, and emergency room trips for diabetes frees up valuable health care resources.
A diabetes diagnosis can be daunting and may bring fear of long-term health maintenance. Misconceptions about daily routines, treatment success rates, and diabetes management can make patients hesitant. Health care providers can reduce these fears by encouraging screenings for at-risk individuals, discussing results clearly, answering questions, and informing patients about available care options.
Engage your patients by opening the conversation about prediabetes, diabetes risks, and prevention options. Consider placing prediabetes screenings in office waiting areas or sharing resources with local diabetes programs to increase awareness and empower patients to take the first step.
Resources for Diabetes Prevention and Management
If you’re interested in learning more about diabetes prevention or if you want to explore programs like the DPP, these resources can help:
- American Diabetes Association (ADA): Visit diabetes.org for information on diabetes prevention, risk factors, and lifestyle tips.
- Centers for Disease Control and Prevention (CDC): The CDC offers resources on prediabetes, type 2 diabetes prevention, and the Diabetes Prevention Program. Find more at cdc.gov/diabetes.
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): Explore educational materials and research on diabetes prevention at niddk.nih.gov.
- Local DPP Programs: Many community centers, health clinics, and hospitals offer diabetes prevention programs. Ask your health care provider for recommendations or visit the ADA and CDC websites to find programs near you.
Taking steps to prevent diabetes or manage prediabetes can have a lasting impact on patient outcomes and community health. Use these resources to support and guide patients on their journey toward improved health.
