Task force issues new clinical guideline for preventing diabetes


A new recommendation for preventing type 2 diabetes based on an in-depth evidence review calls for increased use of evidence-based diabetes prevention programs.

The Community Preventive Services Task Force, a group that identifies population health interventions and makes recommendations to health departments and communities, this week released its findings on how to prevent type 2 diabetes. The task force found that combined diet and physical activity promotion programs, such as diabetes prevention programs that are part of the Center for Disease Control and Prevention’s National Diabetes Prevention Program, are among the best ways to help people with prediabetes reduce their risk of developing type 2 diabetes.

Findings from the task force's extensive evidence review point toward the success of these accessible community-based interventions in helping to halt the onset of one of the nation’s most troubling chronic diseases. This is particularly encouraging at a time when one in three U.S. adults has prediabetes, the precursor to type 2 diabetes.

For the evidence review, researchers screened articles for single-group or comparative studies of combined diet and physical activity promotion programs. Participants at increased risk for type 2 diabetes had to have at least two sessions over at least three months. The researchers extracted data on study design, description (participant, intervention and outcome) and results in order to assess the quality of the studies.

Ultimately, 53 studies were reviewed. They evaluated 66 programs. Compared with usual care, diet and physical activity promotion programs reduced the incidence of type 2 diabetes, decreased body weight, lowered fasting blood glucose level and improved other cardiometabolic risk factors.

The task force also published a related literature review that looked at the cost of these interventions, finding that diet and physical activity promotion programs are cost-effective among persons at increased risk for type 2 diabetes. In addition, costs are lower when programs are delivered to groups in community or primary care settings.

In a related editorial, also published in the Annals of Internal Medicine, Ronald Ackermann, MD, director of the Center for Community Health at Northwestern University Feinberg School of Medicine, explains how diabetes prevention efforts are at the "tipping point."

"As a society, we should no longer hold for ransom the potential to reduce the burden of diabetes by continuing to await further evidence that interventions will be cost-saving or prevent myocardial infarctions or deaths," Dr. Ackermann said in the editorial. "It is imperative that we promote a known cost-effective intervention that improves health, reduces the need for medication, and has the potential to enable millions of Americans to evade a remaining lifetime burdened by the daily management of diabetes."

Successes such as those confirmed in this evidence review have led to a bill that was introduced to Congress. The legislation would require Medicare to cover services provided under the National Diabetes Prevention Program.

A recent study estimated that the legislation could to help reduce the cumulative rate of type 2 diabetes in the Medicare population by 37 percent after a decade, resulting in nearly 1 million fewer cases of diabetes among seniors by 2024. The study also found that the bill could reduce federal spending by $1.3 billion over 10 years.

As part of its Improving Health Outcomes initiative, the AMA worked with the YMCA of the USA and 11 physician practice pilot sites in four states over the past year to develop tools and resources to increase physician screening, testing and referral for prediabetes.

The practices referred their patients with prediabetes to diabetes prevention programs offered by local YMCAs, which were part of the National Diabetes Prevention Program. Medicare beneficiaries were able to participate in this program at no cost, thanks to an award from the Center for Medicare and Medicaid Innovation.

Now physicians across the country can join in this work. The AMA and the Centers for Disease Control and Prevention have teamed up to issue a call to take urgent action with Prevent Diabetes STAT: Screen, Test, Act–Today™. This multi-year initiative helps physicians refer adults who have prediabetes to prevention programs in their communities and online.

Learn how to identify patients with undetected prediabetes, and find effective diabetes prevention programs near your practice.