Congress urged: Save evidence-based diabetes prevention program

A coalition committed to stem the rising tide of type 2 diabetes is calling on Congress to preserve a Centers for Disease Control and Prevention (CDC) program that uses proven and low-cost lifestyle approaches to prevent onset of the disease.

In a letter to House and Senate appropriations subcommittee leaders, signed by 17 members of the of the Diabetes Advocacy Alliance (DAA)—including the AMA—expresses strong support for $25 million in continued funding for the CDC’s National Diabetes Prevention Program (DPP). The Alliance, since 2010, has worked to create awareness and action on the part of legislators and policymakers to fight the disease that already affects 30 million Americans and costs $322 billion a year.

“The human and economic toll of this disease is devastating,” states the Alliance letter, which underscores the urgency of the problem and points to the National DPP as a program “that can help change the trajectory” of diabetes in this country. Among those joining the AMA in the funding plea are the American Association of Clinical Endocrinologists, National Council on Aging, National Kidney Foundation, American Diabetes Association, YMCA of the USA, the Endocrine Society, as well as other nonprofit and corporate signatories.

If the incidence of the disease is unchecked, the forecast is that one in three people in this country will have diabetes by 2050. The public-private National DPP focuses its efforts on halting or delaying the onset of type 2 diabetes. All told, 86 million Americans are at risk of diabetes and, for many, the onset can happen quickly. Among those with prediabetes, 15–30 percent can be expected to progress to type 2 diabetes within five years.

Lifestyle changes pay off

The National DPP confronts this public health crisis by using evidence-based approaches born out of clinical trials conducted by the National Institutes of Health (NIH). In those trials, individuals with prediabetes cut their risk by well over half—58 percent—through “lifestyle intervention and modest weight loss of 5–7 percent,” the Alliance letter notes, adding, “seniors were even more successful, decreasing their risk by 71 percent.”

The success of those trials and support from CDC and its partners, has led to creation of lifestyle-intervention programs by hundreds of organizations. “Further research translating the clinical trials from a one-on-one intervention with a clinician to a community, group-based setting showed the results could be replicated for a cost of $425–$600 per participant,” according to the Alliance. That cost per individual is a small fraction of the thousands of dollars in increased spending per patient annually with the onset of type 2 diabetes.

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The centerpiece of the National DPP is a yearlong program built around a CDC-approved curriculum, and encouragement from both a trained lifestyle coach and a support group of others at risk of diabetes. Sessions are weekly for the first six months and focus on such essentials as weight loss, increased activity, coping with stress and rebounding from lapses. The second six months builds on those skills in meetings once or twice a month designed to maintain healthy lifestyle changes for the long run. Both in-person and online versions are available. The CDC has a tool to locate nearby programs.

In recent years, diabetes prevention has been a major focus of AMA activities in improving health outcomes. Those initiatives harness the positive influence of physicians and other health professionals in connecting patients with the training and lifestyle changes that can take them off the path to type 2 diabetes.

One notable example is the Association’s partnership with the CDC in the Prevent Diabetes STAT™ program. The acronym stands for Screen/Test/Act Today™. The program is an online toolkit designed to aid physicians and other members of the patient care team in identifying and referring at-risk patients to lifestyle-change programs.

The National DPP takes the baton and teaches the proven lifestyle—and, advocates hope, lifelong—changes in settings with enough time, personalization and encouragement to be effective. If approved by Congress, the National DPP appropriation now under consideration would be for fiscal year 2018, which begins Oct. 1.

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