For this clinic, diabetes prevention program is in the house

Type 2 diabetes can often be delayed or prevented with health behavior changes. However, with a lack of referral options for a diabetes prevention program (DPP), an independent practice in suburban Detroit created their own. Since implementation a year ago, the lead physician shares his experience on the clinical success, benefits for patients and the next steps for the practice.

The patient population at Western Wayne Physicians is largely blue-collar residents with their three sites primarily providing care to the region’s auto workers. Many of these patients have prediabetes, which is when blood glucose or hemoglobin A1C levels are higher than normal but not high enough to be classified as type 2 diabetes.

At a time when one in three U.S. adults has prediabetes and 90 percent don’t even know it, Robert Jackson, MD, a family physician at Western Wayne, understood the importance of identifying those patients and helping them get the interventions they needed right away through a DPP.

Clinical success

Previously, DPPs have been found to help patients with prediabetes cut their risk of progressing to type 2 diabetes by 58 percent overall. And for patients 65 years and older, it increases to a 71 percent decrease. Dr. Jackson is also pleased with patient outcomes for his practice’s DPP.

“[The program] worked out well, clinically. The patients by and large, even if they didn’t lose weight, gained perspective,” Dr. Jackson said. “Virtually everyone had a reduction in their hemoglobin A1C.”

“And those who didn’t lose weight, lost inches so they probably gained muscle mass and lost fat, which is good,” he added. “Patients seemed to have positive experiences. In that way, it was a success.”

Related Coverage

With no DPP in reach, a family medicine practice created its own

However, Dr. Jackson added, his practice’s in-house DPP is not yet financially sustainable.

Payers are increasingly covering the service. For example, DPPs are among the newly covered services included in the 2018 Medicare physician fee schedule, with an annual maximum payment per Medicare beneficiary of $670. CMS DPP reimbursement starts April 1. The AMA will be offering educational programs and releasing tools physicians can use to help their patients take advantage of this newly covered service.

The AMA had also recommended that CMS cover virtual prevention programs. But, for 2018 at least, the CMS is only allowing a limited number of virtual sessions to make up for missed attendance at an in-person DPP session.

The Prevent Diabetes STAT toolkit is available to help health care teams screen, test and refer at-risk patients to in-person or online diabetes prevention programs. Physicians are encouraged to:

  • Screen patients for prediabetes using the CDC Prediabetes Screening Test or the American Diabetes Association Diabetes Risk Test.
  • Test patients for prediabetes using one of three blood tests.
  • Act today to help prevent diabetes by referring patients with prediabetes to a diabetes prevention program.

The AMA offers online CME to expand your knowledge in diabetes management. Explore educational content such as “Prevent Diabetes STAT.”