The National DPP → Evidence

 

Evidence

 

Research studies and evaluations have repeatedly shown that interventions such as the National DPP lifestyle change program improve health outcomes and are cost-effective or cost-saving. Evidence supporting these outcomes from both the in-person and online delivery of the National DPP lifestyle change program can be found below. This page is organized under the following headings:

 

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Original and Translational Research Studies

 

Diabetes Prevention Program (DPP) Clinical Trial

The Diabetes Prevention Program was a randomized clinical trial funded by the National Institutes of Health (NIH) and supported by the CDC that began in 1996. A total of 1,079 participants experienced a lifestyle intervention that resulted in a 58% reduction in the rate of diabetes. The goals of the intervention were a 7% reduction in weight and 150 minutes a week of physical activity. It featured individual coaching, a 16-session core curriculum, supervised physical activity, and other supports.

10 and 15-year follow up studies were also completed. The 15-year follow up study substantiated that diabetes incidence was reduced by 27% in the group that experienced the intervention, and that “cumulative diabetes incidences” was 55% as compared to 62% in those who had not had an intervention.

For more information on the Diabetes Prevention Program clinical trial, click here.

The 10-year follow up study can be found here.

The 15-year follow up study can be found here.

The 21-year follow up study can be found here.

 

Diabetes Education & Prevention with a Lifestyle Intervention Offered at the YMCA (DEPLOY) Pilot Study

In 2008, the DEPLOY Pilot Study examined the feasibility of offering the DPP clinical trial intervention in community settings, using a lower-cost group-based model. Trained YMCA wellness instructors facilitated the group sessions. Participants in the relatively small cohort successfully lost 6% of their body weight.

For more information on the YMCA pilot study, click here.

 

Translation of Diabetes Prevention Programs into Real-World Settings

Randomized control trials provided evidence for the efficacy of intensive lifestyle interventions such as the National DPP lifestyle change program, but how do these programs translate into real life outside of such controlled settings? A 2013 review of 17 translational studies that implemented either the U.S. National DPP lifestyle change program or the Finnish Diabetes Prevention Study found that weight loss occurred for intervention participants in all but one study. The review concluded that “there is potential for less intensive interventions both to be feasible and to have an impact on future progression to diabetes in at-risk individuals.”

For more information on this study, click here.

 

Public Health Approaches to Type 2 Diabetes Prevention

Along with the large randomized control trials conducted in the United States on the National DPP lifestyle change program, many other nations have evaluated the effectiveness of intensive, structured, yearlong educational programs focused on moderate weight loss in preventing type 2 diabetes. Studies performed in China, Finland, Greece, Japan, India, Europe, and Australia have demonstrated the flexibility and applicability of this type of intervention across geographic settings.

An analysis of Diabetes Prevention Recognition Program (DPRP) data from February 2012 to January 2016, describing 14,747 program participants across 220 CDC-recognized organizations who attended four or more sessions, found an average weight loss of 4.2%. 35.5% of participants achieved over 5% weight loss. Additionally, 41.8% completed 150 minutes per week of physical activity.

DPRP data also shows that between February 2012 and January 2019 more than 297,000 participants attended one or more National DPP lifestyle change program sessions. 143,489 of the participants were eligible to be included in a bivariate and descriptive analysis, which found that 60% attended the program via online-only, 40% via in-person only, and less than 1% via distance learning only or a combination modality. About 40% attended at least 17 sessions, 31% met the 5% weight loss goal, and 45% met the average 150+ minutes per week of physical activity. Three quarters were females, and over half were aged 45-64 years.

The full review can be accessed here.

 

Translating Knowledge into Action: Medicare Coverage of the National DPP Lifestyle Change Program

In 2018, the Centers for Medicare and Medicaid Services (CMS) translated evidenced-based intervention into policy by extending coverage of the National DPP lifestyle change program to Medicare beneficiaries through the Medicare Diabetes Prevention Program (MDPP).

In a 2020 study, researchers used the Knowledge to Action framework (K2A) to understand how the National DPP lifestyle change program was translated from research into a Medicare covered benefit. The researchers identified four milestones:

1. Strong evidence base: Evidence of the National DPP lifestyle change program’s efficacy is based in the DPP Clinical Trial, a randomized clinical trial with 10, 15, and 21-year follow up data. Follow-up studies and international studies have spanned different implementation types and settings to confirm the effectiveness of this intervention in preventing or delaying type 2 diabetes.
2. Cross-sector engagement to create a national infrastructure: CDC gathered public, private, academic, and community institutions to develop a sustainable infrastructure for delivery of the National DPP lifestyle change program and to create quality standards. When the program became a Medicare-covered benefit, CMS was able to largely rely on CDC for quality assurance through this infrastructure.
3. Evidence of effectiveness with the Medicare population: CMS funded 17 YMCA-USA sites to deliver the National DPP lifestyle change program to Medicare beneficiaries, which demonstrated significant cost savings and reductions in inpatient stays and emergency department visits.
4. Extensive public input into the MDPP: Stakeholders submitted thousands of comments across two rulemaking cycles to inform the details of the model. CMS was required to respond to the comments and either make policy changes or describe why certain policies could not be modified, and consequently established multiple policies in response to the public comments.

Policy makers, payers, and employers can look to the same evidence as they consider offering the National DPP lifestyle change program as a covered benefit. Additionally, the successful adoption of the National DPP lifestyle change program as a Medicare-covered benefit can serve as a model for scaling other evidence-based interventions.

The full article can be accessed here.

Translating the Diabetes Prevention Program into American Indian and Alaska Native Communities

In this research study, a translational implementation of the National DPP intervention was conducted in a diverse set of American Indian and Alaska Native (AI/AN) communities. The findings demonstrate the feasibility and potential of translating the lifestyle intervention in diverse AI/AN communities and have important implications for dissemination and institutionalization of the intervention throughout the Native American health system.

For more information on the study, click here.

 
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Evaluation

 

The Center for Medicare & Medicaid Innovation (CMMI) Health Care Innovation Awards – YMCA of the USA (Y-USA) Implementation

Many additional studies have been conducted on variations of the DPP intervention. One evaluation conducted by RTI International assessed a Y-USA implementation of the National DPP lifestyle change program with Medicare beneficiaries. The Y-USA received an $11M CMS Health Care Innovation Award to implement and evaluate the program with Medicare beneficiaries in 17 YMCA locations. The goals of the intervention were to support participants in losing at least 5% of their body weight and exercising 150 minutes per week. The participants received group coaching. RTI found that in the first five quarters of the program, savings amounted to $2,636 per participant. Through the first 11 quarters, those attending at least one core session lost 3.8% of their body weight, and those attending at least four core sessions lost 4.5% of their body weight.

A 2017 claims analysis of the total medical costs for fee-for-service Medicare National DPP lifestyle change program participants revealed an overall weighted average savings of $278 per member per quarter during the first three years when compared to a group of non-participants. The participant group also had nine fewer inpatient stays and nine fewer emergency department visits per 1000 participants per quarter. The claims analysis concluded that these results justify continued support for the National DPP lifestyle change program for Medicare beneficiaries.

For more information see the YMCA of the USA DPP 2015 Annual Report. For additional data reports from this project, see CMS’ Health Care Innovation Awards page.

The 2017 three-year claims analysis study can be accessed here.

CMMI continues to evaluate the program. Please see the MDPP Expanded Model Findings at a Glance Evaluation of Performance April 2018 – December 2021.

 

Participant-Level Evaluation of CDC’s National Diabetes Prevention Program, 2017

A recent article in Diabetes Care analyzes data from the CDC’s DPRP and concludes that greater duration and intensity of session attendance resulted in a higher percent of body weight loss overall and for subgroups. Focusing on retention may reduce disparities and improve overall program results. Further program expansion and investigation is needed to continue lowering the burden of type 2 diabetes nationally.

To read this article, click here.

 

Oregon Health & Science University (OHSU) Center for Evidence-based Policy

The Center for Evidence-based Policy at OHSU produced a report in October 2017 discussing the long-term health effects of dietary and physical activity changes such as those used in the diabetes prevention program. This report reviews the long-term effects of combined diet and physical activity focused lifestyle interventions on individuals with prediabetes or at high risk for diabetes. The lifestyle interventions evaluated in this report either used the protocol from the diet and physical activity arm of the original Diabetes Prevention Program (DPP) randomized controlled trial (RCT) (i.e., DPP intervention), or used a similar lifestyle intervention to the original DPP RCT diet and physical activity protocol (i.e., DPP-like intervention). This report also includes an evaluation of the long-term effectiveness of variations in program delivery or population subgroups for DPP or DPP-like interventions.

For a copy of this report click here.
 

Using a RE-AIM Framework to Identify Promising Practices in National DPP Implementation

In 2012, the Centers for Disease Control and Prevention funded six national organizations to scale and sustain multistate delivery of the National DPP lifestyle change program. This study aims to describe reach, adoption, and maintenance during the 4-year funding period and to assess associations between site-level factors and program effectiveness regarding participant attendance and participation duration.

Some study highlights include:

• Site-level strategies significantly associated with higher overall attendance, attendance in months 7–12, and longer participation duration included using self-referral or word of mouth as a recruitment strategy, providing non-monetary incentives for participation, and using cultural adaptations to address participants’ needs.
• Sites receiving referrals from healthcare providers or health systems also had higher attendance in months 7–12 and longer participation duration.

To access the study, click here.
 

Enrollment Characteristics and Results for Adults Aged 18-44 in the National DPP

This CDC analysis examined the characteristics of individuals aged 18-44 who enroll in the National DPP lifestyle change program, as well as some of the outcomes associated with this subgroup of participants. Results highlight the opportunity to develop strategies focused on supporting younger adults to enroll in and complete the National DPP lifestyle change program.

To access the research poster, click here.
 

Effect of Organization Type on Priority Population Outcomes in the National DPP

This CDC analysis examined data from 624,422 lifestyle change program participants to determine the impact of CDC-recognized organization type, including community centers, higher education, government, health care providers, and for-profit/insurers on people who are at increased/higher risk for type 2 diabetes. Results indicate that certain types of organizations might better serve priority populations with respect to reducing their risk of developing type 2 diabetes.

To access the research poster, click here.
 

Impact of Participant Characteristics on Weight Loss in the National DPP (2012-2021)

This CDC analysis assessed the association between lifestyle change program participant characteristics (demographics and type of program enrolled in) and achieving the 5% weight loss goal. Results of this analysis indicate that participant characteristics, such as racial/ethnic group or age, strongly impact whether someone meets the program weight loss goal. Program delivery strategies tailored to specific populations could be effective in helping participants achieve programmatic goals.

To access the research poster, click here.
 

Gestational Diabetes

Effectiveness of the National Diabetes Prevention Program After Gestational Diabetes

In this evaluation conducted in a large network of Federally Qualified Health Centers, diverse younger women with prior gestational diabetes attending the National DPP lifestyle change program were found to have one-third greater attendance and twice as much weight loss compared with all other participants. This stands in contrast to previous research showing lower attendance and weight loss among younger women. However, the population in this evaluation represented a small proportion (3.8%) of enrollees. As described in this article, the National DPP lifestyle change program appears to be an effective but underutilized resource for this high-risk population.

For more information on this study, click here. Please note there is a cost to download the article without a subscription.

The Effect of Lifestyle Intervention on Women with Gestational Diabetes

This ten-year randomized controlled clinical trial found that individuals with a previous gestational diabetes diagnosis were 48% more likely to develop type 2 diabetes than those without. It also found that successful completion of the National DPP lifestyle change program reduced progression to diabetes for these individuals by 35%.

To access the study, click here.

Key Outcomes in Women with a History of Gestational Diabetes Participating in a Diabetes Prevention Program

This evaluation of National DPP lifestyle change program outcomes compared participation, self-monitoring behavior, weight loss, and cardiometabolic risk reduction among women with and without a previous gestational diabetes diagnosis. Authors concluded that individuals with a previous gestational diabetes diagnosis can be highly successful in the program and achieve significant weight loss.

To access the study, click here.

The National DPP Lifestyle Change Program After Gestational Diabetes

This 2023 research recommends that individuals with a previous gestational diabetes diagnosis participate in the National DPP lifestyle change program postpartum to decrease and delay risk of developing type 2 diabetes. Authors suggest that participation in the program may also decrease participants’ risk of developing gestational diabetes in future pregnancies.

To access the study, click here.

Diabetes Prevention Education Impact Across Generations

This study of diabetes prevention education programs for individuals with gestational diabetes found that participation in these programs can indirectly benefit the children of individuals participating in the program. Since children of gestational diabetes pregnancies face an increased risk for obesity and type 2 diabetes, parents developing healthy eating and physical activity behaviors through the program can have long-term benefits for their children as well.

To access the study, click here.
 

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Cost

 

CMS Office of the Actuary (OACT) Certification Report

In March 2016, the CMS Office of the Actuary (OACT) released a certification report for expansion of the Y-USA National DPP lifestyle change program. It reviewed results from the first two years of the Y-USA National DPP lifestyle change program implementation (referenced above), the original DPP clinical trial, and a subset of lifestyle change programs recognized by the CDC. The report confirmed the results and certified that an expansion of DPP in the Medicare population would reduce (or not increase) net-Medicare spending.

For more information on the CMS OACT report, click here.
 

The Cost of Diabetes, American Diabetes Association, 2022

Diabetes has both serious health and economic consequences. These latest figures from the American Diabetes Association indicate direct and indirect estimated annual costs of $412.9 billion as a result of diabetes, individuals with diabetes face on average 2.6 times higher health care costs than those without diabetes, and 1 in 4 health care dollars are spent treating diabetes and its complications.

To learn more, click here.
 

Trends in Medical Expenditures Prior to Diabetes Diagnosis

This analysis finds that the incremental rise in costs of diabetes are shown to begin at least 5 years before diagnosis of the disease and accelerate immediately after diagnosis. Results suggest that the newly diagnosed case subjects spent $8941 more than control subjects not diagnosed with diabetes over the span of 5 years, with approximately $4828 in the year of diagnosis. Results show that the rise in medical spending associated with diabetes begins well in advance of the first diabetes diagnosis and support the need to encourage physicians to implement timely identification and prevention efforts to reduce the economic burden of the disease.

For more information on this study, click here.
 

The Cost of Diabetes in Medicaid

Several research studies demonstrate the costs of diabetes related care in Medicaid. A few examples of these studies are summarized in this table which also highlights the methodology and data sources used.
 

Institute for Clinical and Economic Review (ICER)

In May 2016, the Institute for Clinical and Economic Review (ICER) released a Draft Evidence Report, “Diabetes Prevention Programs: Effectiveness and Value.” The report was subsequently finalized. The report assessed 10 U.S. National DPP lifestyle change programs with full or pending recognition from the CDC’s DPRP. The report concluded that the programs (using in-person group coaching or an online format with a human coach) provided “an incremental or better” net health benefit. It also concluded that online programs with fully automated (not human) coaching provided “comparable or better” net health benefit versus standard care.

For more information on ICER, click here.

 

Online Delivery of the National DPP Lifestyle Change Program Return on Investment

A study entitled “Return on Investment for Digital Behavioral Counseling in Patients With Prediabetes and Cardiovascular Disease” looked at 2,371 individuals with prediabetes, and/or who were at risk for cardiovascular disease. The participants enrolled in an online prevention program through Omada Health between 2012 and 2014 that exceeded the DPRP standards. The study used a Markov-based model to simulate clinical and economic outcomes annually over 10 years using 26-week weight loss results from the program. The simulated return-on-investment break-even point was 3 years for both populations, with a simulated five-year return on investment of $1,565 for the prediabetes population. These findings suggest that online delivery of prevention programs can have a positive return on investment.

For more information on this study, click here.

 

Cost-Effectiveness of Interventions to Prevent and Control Diabetes Mellitus: A Systematic Review

A review of 44 studies concluded that diabetes prevention lifestyle modification programs achieved clinically meaningful weight and cardiometabolic health improvements, and another review found that combined diet and physical activity programs lowered systolic and diastolic blood pressure and improved lipid levels.

 

The Value of a Return on Investment in Promoting Prevention: One Center’s Journey and Perspective

The Providence Medical Group Endocrinology, Diabetes and Nutrition Center, part of Providence Health and Services Health System located in Missoula, Montana, wrote up their experience with the DPP in their facility, including the path to coverage and the cost-benefit and ROI of the program.

For more information, click here.

 

The Cost-Effectiveness of Diabetes Prevention: Results from the Diabetes Prevention Program and the Diabetes Prevention Program Outcomes Study

A review of the National DPP clinical trial was done from the perspective of resource utilization, costs of the interventions, costs of the non-intervention medical care, the impact of the interventions on diabetes progression and quality of life, and the cost-effectiveness of the interventions from health system and societal perspectives. The data was analyzed over 3- and 10-year periods and indicated cost-efficacy and quality of life improvements for high-risk individuals.

For more information on this study, click here.

 

The Cost-Effectiveness of Lifestyle Modification or Metformin in Preventing Type 2 Diabetes in Adults with Impaired Glucose Tolerance

A 2013 study of the long-term effects of diabetes prevention programs found that after ten years the intensive lifestyle intervention achieved a comparable positive long-term effect on cardiovascular disease risk factors as was seen in metformin and placebo groups. A 23-year study of people with impaired glucose tolerance concluded that the cumulative incidence of cardiovascular disease mortality decreased from 19.6% in the control group to 11.9% in the group with a lifestyle intervention.

 

Medical Care Expenditures for Individuals with Prediabetes: The Potential Cost Savings in Reducing the Risk of Developing Diabetes

A team of researchers evaluated the differences in health care costs between individuals with pre-diabetes who progress to type 2 diabetes, versus those that do not. They found medical expenditures to be nearly one-third higher for those who develop diabetes, and indicate that lifestyle change programs such as the National DPP could yield positive net savings on medical care expenses and ROI.

For more information on this study, click here.

 

Potential Reduction in Medical Costs

This study, which conducts a retrospective analysis of claims data from the Truven Health MarketScan® Commercial Claims Database, examines costs associated with diabetes five years before diagnosis. Results confirm that the rise in mean medical spending associated with diabetes long precedes diagnosis and is greatest in the year diabetes is diagnosed. “Overall, total per capita annual spending for outpatient, inpatient, and pharmaceuticals among case subjects rose 2.0 times […] leading up to the diagnosis of diabetes […].”

 

Cost Effectiveness of Type 2 Diabetes Prevention Programs: A Systematic Review

A systematic review of the cost effectiveness of type 2 diabetes (T2D) prevention approaches found that both high-risk and population-based approaches are an efficient use of resources. High-risk approaches include (1) translational DPP interventions, which follow the National DPP curriculum, (2) translational non-DPP interventions, which do not follow the National DPP, and (3) pharmacological interventions. Population-based prevention approaches include campaigns, policy, and other community-based strategies. While all approaches were cost-effective, effectiveness varied. Lifestyle interventions were more cost-effective than pharmacological interventions, and translational DPPs were significantly more cost-effective than translational non-DPPs.

 

Cost Effectiveness of a Community-Based Diabetes Prevention Program with Participation Incentives for Medicaid Beneficiaries

Researchers studied 847 non dual-eligible Medicaid enrollees at high risk for type 2 diabetes. Participants attended the National DPP lifestyle change program and were provided with study materials, transportation, childcare, three-month’s access to exercise facilities, a one-time $25 incentive for attendance, and $25 reimbursement for a clinical follow-up visit. Some participants also received additional participation and outcome-based incentives, but there were no statistically significant differences for those who received these extra incentives and those who did not.

On average, participants attended 12 of 24 National DPP lifestyle change program sessions, lost an average of 4.2 lbs. over a median of 17 weeks, and increased high-density lipoprotein cholesterol by 1.75 mg/dl. Intervention costs were $915 per participant. The program was considered cost-effective by commonly accepted standards when considering both sustained weight loss over time and when assuming only 50% of weight loss persisted after five years.

Access the full article here. Please note there is a cost to download the article without a subscription. If you would like to read the article, please email coveragetoolkit@chronicdisease.org.

 
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Statistics and Burden

 

National Diabetes Statistics Report, 2022

The National Diabetes Statistics Report is a periodic publication of the Centers for Disease Control and Prevention (CDC) that provides updated statistics about diabetes in the United States for a scientific audience. It includes information on prevalence and incidence of diabetes, prediabetes, risk factors for complications, acute and long-term complications, deaths, and costs. These data can help focus efforts to prevent and control diabetes across the United States. This report was previously known as the National Diabetes Fact Sheet.

The 2022 National Diabetes Statistics Report can be accessed here.
 

Trends and Characteristics in Gestational Diabetes: United States, 2016-2020

Among women giving birth in the United States in 2020, the overall rate of gestational diabetes mellitus (GDM) was 7.8% , a 30% increase from 2016. Rates increased an average of 5% annually from 2016 to 2019 and then increased 13% from 2019 to 2020. GDM can lead to negative health outcomes for both mothers and infants, including an increased risk of developing type 2 diabetes later in life. This report describes trends and differences in GDM rates from 2016 through 2020 by maternal race and Hispanic origin, maternal age, body mass index (BMI), birth plurality, and state of residence.

To access the report, click here.
 

Gestational Diabetes Rate Up Significantly in US

The rate of gestational diabetes in the US has increased in all racial, ethnic and age groups, researchers wrote in the Journal of the American Medical Association. A serial cross-sectional analysis of National Center for Health Statistics data on 12,610,235 women and girls aged 15 to 44 years with singleton first live births found the rate of GD increased from 47.6 to 63.5 per 1,000 live births from 2011 to 2019.
 

New Research Uncovers Troubling Increases in Youth Living with Diabetes in the US

According to a report published today in JAMA, diagnosed cases of type 1 and type 2 diabetes are surging among youth in the United States. Using data from the CDC- and NIH-cosponsored SEARCH for Diabetes in Youth Study, results show that from 2001 to 2017, the number of youth aged 0-19 living with type 1 diabetes increased by 45%, and the number living with type 2 diabetes nearly doubled. The report also shows the greatest increases in type 1 diabetes occurred in White and Black youth, while type 2 diabetes diagnoses skyrocketed among Black and Hispanic youth. Read the full article here.

For more information on the Community Preventive Services Task Force, click here.
 

Assessing Type 2 Diabetes Risk

The Longitudinal Epidemiologic Assessment of Diabetes Risk (LEADR) study used a novel electronic health record (EHR) data approach as a tool to assess the epidemiology of known and new risk factors for type 2 diabetes and study how prevention interventions affect progression to and onset of type 2 diabetes. This study created an electronic cohort of 1.4 million patients that had at least 4 encounters with a healthcare organization for at least 24-months; were aged ≥18 years in 2010; and that had no diabetes at cohort entry or in the 12 months following entry. Of that cohort, approximately 5.9% (82,922 patients)of patients developed type 2 diabetes over the seven-year study period.

To access the study, click here.
 

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Evidence-Based Recommendations

 

Community Preventive Services Task Force

The Community Preventive Services Task Force conducted a review of 53 studies (from January 1991 through February 2015) based on 66 combined diet and physical activity promotion programs. The Task Force concluded that such interventions are cost-effective, and recommended diet and physical activity promotion programs for individuals at increased risk for developing type 2 diabetes. It made this recommendation based on “strong evidence of effectiveness in reducing new-onset diabetes.”

For more information on the Community Preventive Services Task Force, click here.
 

National Clinical Care Commission: Report to Congress on Leveraging Federal Programs to Prevent and Control Diabetes and Its Complications, 2021

The National Clinical Care Commission, a federal advisory committee, has released its final report outlining evidence-based, actionable recommendations to improve federal diabetes awareness, prevention, and treatment programs for diabetes. The Commission’s report — the first of its kind since 1975 — calls for additional federal efforts to improve access to health care, address the social determinants of health, and improve collaboration among different agencies. The National DPP lifestyle change program and the MDPP figure prominently in the recommendations.
 

USPSTF Recommendations

The United States Preventive Services Task Force (USPSTF) is an independent panel of experts that publishes recommendations for evidence-based clinical preventive services. The Affordable Care Act requires a subset of health plans to cover items and services with a grade A or B USPSTF recommendation without cost-sharing for the relevant member. The counseling requirements for abnormal blood glucose, healthful diet and physical activity, gestational diabetes, and obesity can be met through coverage of the National DPP lifestyle change program. These recommendations will bring additional attention to prediabetes and may create momentum around the development of prediabetes measures.

For more information on USPSTF Recommendations, please see the Quality Metrics page.
 

Center for Medicare & Medicaid Innovation (CMMI) Medicaid Incentives for the Prevention of Chronic Diseases (MIPCD) Grants

To date there has been limited published data and analysis on the National DPP lifestyle change program in Medicaid populations. Minnesota, Montana, Nevada, and New York have received Medicaid Incentives for the Prevention of Chronic Diseases (MIPCD) grants where a portion of the grant dollars funded incentives for National DPP lifestyle change program participants. Final evaluations of these programs may surface additional information about cost-effectiveness and health outcomes as it pertains to the National DPP lifestyle change program in Medicaid.

For more information on CMMI MIPCD grants, click here. For a copy of the final report, click here.
 

Effectiveness of Incentives for Improving Diabetes-Related Health Indicators in Chronic Disease Lifestyle Modification Programs

In 2022, CDC published a research study about the use of incentives in lifestyle modification programs (like the National Diabetes Prevention Program [National DPP] lifestyle change program and diabetes self-management education and support services) and how they can benefit participants. The manuscript details how individuals in lifestyle modification programs who received an incentive improved their body weight, body mass index, and blood pressure more than participants who did not receive an incentive.

To access the study, click here.
 

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Additional Benefits

 

Benefits Related to CVD Risk Reduction

Several studies have found that lifestyle intervention programs can reduce the risk of cardiovascular disease. For example, a 2005 randomized clinical trial found that an intensive lifestyle intervention designed to achieve and maintain a 7% weight loss and 150 minutes of exercise per week decreased the incidence of metabolic syndrome (i.e., increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels that occur together) by 41%.

 

Benefits Related to Weight Loss and Reduction of Sleep Apnea

Another benefit of the National DPP lifestyle change program is the reduction of sleep apnea. A study of obese adults with type 2 diabetes and obstructive sleep apnea found that over four years, intensive lifestyle intervention produced greater reductions in weight and sleep apnea than diabetes support and education only. An analysis of two systematic reviews and eight randomized control trials of overweight or obese individuals who had obstructive sleep apnea also found that intensive lifestyle interventions resulted in significant weight loss and reduction in sleep apnea severity. Similarly, a systematic review and meta-analysis of 12 controlled trials found that intensive lifestyle management can significantly reduce obesity indices and decrease the severity of sleep apnea.

 

Other Benefits on Health-Related Quality of Life, Mental Health, and Well-Being

The National DPP lifestyle change program can also improve general health, physical function, reduce bodily pain, and improve vitality scores on a health survey after three years. Similarly, another study concluded that weight loss because of the National DPP lifestyle change program was associated with improvements in measures of health-related quality of life. Finally, a study of a work place diabetes prevention lifestyle change program found improved metabolic and behavioral risk factors among employees with prediabetes.

 

Reduces Risks of Cognitive Decline

Individuals with higher HbA1c levels may have poorer brain health and increased cognitive decline compared to individuals with normal levels. One study shows memory loss as the most reported adverse side effect of prediabetes and known diabetes, but these conditions are also associated with poorer processing speed, concentration, attention, and executive functions. Specifically, prediabetes and known diabetes are positively associated with vascular dementia (VD), cognitive decline, Alzheimer’s dementia (AD) risks, lower hippocampal volume (HV), and white matter hyperintensities (WMH) volume.

 
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Telehealth

 

Feasibility of Telehealth Delivery of the National DPP Lifestyle Change Program in Montana

In 2009, Holy Rosary Healthcare and the Montana Department of Public Health and Human Services tested the feasibility of delivering an adapted National DPP lifestyle change program through video conferencing. This study compared 13 individuals participating in the program on-site with 16 individuals participating through telehealth. There were no significant differences between the groups. Over 45% of on-site and telehealth participants achieved the 7% weight loss goal with an average weight loss per participant greater than 6.4 kg in both groups. The findings suggest that it is feasible to deliver the adapted National DPP lifestyle change program through telehealth.

For more information on this study, click here. Additional information about how the National DPP lifestyle change program is delivered through telehealth in Montana can be found on the Montana State Story page.

 

Telehealth Delivery of the National DPP Lifestyle Change Program to Rural Communities in Montana

In 2017, Holy Rosary Healthcare and the Montana Department of Public Health and Human Services published a study comparing the participation, diet monitoring, physical activity, and weight loss of participants receiving the National DPP lifestyle change program in-person and participants receiving the program through telehealth between 2008 and 2015. Using a distance learning approach, the telehealth participants were able to see and communicate with the lifestyle coaches and on-site participants in real-time. The study, which included 894 program participants, found that there were no statistically significant differences in the number of sessions attended, the mean weight loss, or the reduction in BMI between the in-person participants and the telehealth participants. There were also no statistically significant differences in the percentage of participants who achieved ≥5% weight loss or the 7% weight loss goal. These findings suggest that providing the National DPP lifestyle change program through telehealth is as effective at encouraging participation and weight loss as providing the program in-person.

To access this study, click here. Additional information about how the National DPP lifestyle change program is delivered through telehealth in Montana can be found on the Montana State Story page.

 

Telehealth Delivery of the National DPP Lifestyle Change Programs to Multiple Rural Communities Simultaneously in Montana

In 2018, Holy Rosary Healthcare and the Montana Department of Public Health and Human Services published a study comparing the effectiveness of a 16-week National DPP lifestyle change program delivered to multiple rural communities simultaneously through telehealth from a single urban community (Rural-16), to a 16-week program in one urban community delivered face-to-face (Urban-16), and to a 12-week program delivered to multiple rural communities through telehealth (Rural-12). All three groups included six-monthly or bimonthly sessions after the core period was completed. A total of 667 participants from 2010 to 2015 were analyzed. The study found that weight loss results from Rural-16 were comparable to weight loss results from Urban-16 for all weight loss outcome goals, demonstrating that the National DPP lifestyle change program can be successfully administered to multiple rural communities simultaneously using telehealth. Overall, the Urban-16 and Rural-16 groups performed better than the Rural-12 groups, although two Rural-12 communities had similar results as the Urban-16 and Rural-16 groups. These findings suggested that unique local factors, such as access to exercise facilities, influence the success of the 12-week National DPP lifestyle change program. However, the study findings do not support the use of a 12-week National DPP lifestyle change program.

For more information on this study, click here. Additional information about how the National DPP lifestyle change program is delivered through telehealth in Montana can be found on the Montana State Story page.

 

Effects of a Digital Diabetes Prevention Program: An RCT

This randomized controlled study compared the effectiveness of a digital Diabetes Prevention Program (d-DPP), a year-long asynchronous program with a Lifestyle Coach and cohort, with a control group that received one two-hour diabetes prevention training. Participants in the d-DPP showed meaningful reduction in HbA1c (-2.3%) and weight loss (-5.49%), both of which were significantly larger effects than the control group. Twenty percent of the population studied were age 65 and over, indicating a potentially promising strategy for the Medicare population. The authors conclude that given the effectiveness of the d-DPP and the capacity for scale and sustainability, d-DPPs show significant potential for widespread dissemination and impact.

For more information on this study, click here.

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Online

 

Two-Year Results of the Online Delivery of the National DPP Lifestyle Change Program

Omada offers an online version of the National DPP lifestyle change program where each participant receives a wireless scale, is part of a 10 to15 person virtual group, and has an assigned health coach. A two-year study found that the 155 individuals who completed the program lost a mean 4.9% of their baseline body weight after one year and 4.3% after two years. Individuals who completed the program also had reduced A1c levels by 0.40% after year one and 0.46% after two years.

To access the study, click here.

 

Three-year Results of the Online Delivery of the National DPP Lifestyle Change Program

A non-randomized trial of patients who participated in the National DPP lifestyle change program through online delivery, related patient engagement during the first year to sustained weight loss after three years. The trial found that participants who participated in four or more lessons during the first year sustained -3.0% weight loss after three years. Participants who participated in nine or more lessons during the first year sustained -2.9% weight loss after three years.

For a copy of this study, click here.

 

Pilot of Online Delivery of the National DPP Lifestyle Change Program

Canary Health pilot tested an online version of the National DPP lifestyle change program that was delivered using audio-narrated lessons. The program included e-mail prompts, automated weekly progress reports, and as-needed communication with a lifestyle coach. Out of 50 pilot participants, 45 completed the program. Individuals who completed the program lost an average of 4.79 kg and systolic blood pressure dropped an average of 7.33 mm Hg.

To access the study, click here.

 

Feasibility of Adapting Online Delivery of the National DPP Lifestyle Change Program for Low-Income Patients

Researchers collaborated with Omada to determine the feasibility of adapting online delivery of the National DPP lifestyle change program for low-income and Hispanic patients. The researchers used focus group feedback to adapt the curriculum to a 5th-grade reading level, adapt content to be culturally appropriate, and create a Spanish version of the curriculum. The low-income and Hispanic populations displayed high engagement and satisfaction with the revised programs.

For a copy of this study, click here.

 

Success of Online Delivery of the National DPP Lifestyle Change Program to Older Adults

An observational study found that individuals in the Medicare population who were willing to attempt to use an online version of the National DPP lifestyle change program were able to meaningfully engage with it. Participants lost 7.5% of their body weight at 12 months. While this study is not generalizable to the entire population of older adults, it provides evidence that online delivery of the National DPP can be successful for older populations.

For more information on this study, click here.

 

Evaluation of Online Delivery of the National DPP Lifestyle Change Program in a Workforce

This study used a matched comparison to compare 634 employees of Iron Mountain, Inc. and their dependents who self-selected to participate in the National DPP lifestyle change program online through Omada to 1,268 employees and dependents who did not. A total of 31% of program participants lost at least 5% of their starting body weight, compared with 20% for the comparison group. Additionally, 22% of program participants dropped one or more BMI category (i.e., from overweight to normal weight, or from obese to overweight, etc.), compared with 15% of matched individuals in the comparison group. Across all program enrollees in the company, 775 (94.2%) completed at least four lessons during the first 16 weeks, and 685 (82.6%) completed at least nine lessons. These findings support the feasibility of utilizing online delivery of the National DPP lifestyle change program in the workplace.

The full study is available here.

 

Qualitative Study of Female Veterans’ Experience with Online Delivery of the National DPP Lifestyle Change Program

Diabetes has proven to be a significant health problem for the veteran population in the United States. This study explored qualitatively semi-structured interviews with 15 female veterans who participated in the National DPP lifestyle change program online through Omada. Some of the key themes from the interviews were that the program was convenient, it easily integrated into their daily routines, and it helped them stay accountable.

To access the journal article, click here.

 

Online Delivery of the National DPP for Medicaid Beneficiaries

Online delivery of the National DPP lifestyle change program has been hypothesized to alleviate the logistical and structural barriers some rural or low-income patients face when engaging with the program. This paper describes the study design and methods for a non-randomized controlled trial to test if an underserved, low-income population would engage in online delivery of the program. 230 participants recruited from three health care facilities serving low-income populations received a language and literacy adapted version of the program for low-income individuals through Omada. An initial qualitative analysis found that a majority of the participants were receptive to an online program and had access to a computer or mobile device. This paper also describes challenges and barriers related to referrals, enrollment, and data collection.

Find the full text of this paper here.
 

Delivering the National Diabetes Prevention Program: Assessment of Enrollment in In-Person and Virtual Organizations

The study analyzes the cumulative enrollment in the National DPP lifestyle change program by delivery mode. The study concluded that reaching more people with the National DPP lifestyle change program will require multipronged and innovative strategies to address challenges associated with participant and health care provider awareness, access to programs, payment issues, and organizational capacity. Additionally, it assesses the various strengths of the different delivery modes that can help organizations choose the best one for them to help overcome some of these challenges.

To access the study, click here.
 

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Content Updated: May 23, 2024