<p>Current Perspectives on the Impact of the National Diabetes Prevention Program: Building on Successes and Overcoming Challenges</p>

Abstract

To address the public health and economic burden of type 2 diabetes, the Centers for Disease Control and Prevention (CDC) began dissemination of the National Diabetes Prevention Program (NDPP) in the United States in 2010. Based on the intensive lifestyle intervention from a large efficacy trial, the NDPP aims to reduce incidence through lifestyle change and weight loss. This narrative review summarizes evidence on reach, effectiveness, and sustainability of the NDPP, while highlighting opportunities to overcome challenges in these areas. Major successes include reaching hundreds of thousands of at-risk individuals across the nation, with notable effectiveness upon full participation and widespread insurance coverage. Yet, more work is needed to ensure greater public health impact, particularly among priority populations at heightened risk who also experience disparities in program outcomes. Preliminary evidence suggests a number of strategies may improve reach and effectiveness of the NDPP, often with more rigorous study needed prior to widespread uptake. Updating the NDPP to better match the current evidence-base may also be important, such as directly targeting glycemia with a patient-centered approach and promoting metformin as an adjunct or second-line treatment. Finally, revisiting pay-for-performance reimbursement models may be critical to sustainability by ensuring adequate availability of suppliers and ultimately reducing diabetes prevalence.

Effects of a Digital Diabetes Prevention Program: An RCT

“…29 Health economic analyses show that in-person DPPs are at least cost neutral 30 and cost saving, 31 which strongly supports payer's return on investment in this preventive service. With the MDPP payment model insufficiently covering the cost of inperson services 32 and the current supply of in-person MDPP providers insufficient to meet the need, 31 leveraging technology and opening access to digital DPPs may solve the demand for suppliers while offering older adults a more accessible format.…”

Impact of Maintenance Session Attendance and Early Weight Loss Goal Achievement on Weight Loss Success in a Community-Based Diabetes Prevention Program Intervention

“…As of April 2019, over 324,000 participants across more than 3000 organizations have participated in DPPbased lifestyle interventions. 18 Yet many feasibility issues remain unanswered for community implementation of the program, 19 including the impact of maintenance sessions on program success and effectiveness as well as the benefit of these programs in Medicare-eligible older versus middle-aged adults. Thus, this investigation examined the association between DPP-GLB maintenance session attendance and (1) achievement of the 5% weight loss goal at 12 months in all participants and by Medicare eligibility and (2) how this association was modified by having met the weight loss goal at 6 months.…”

The Effectiveness of a Proactive, Three-Level Strategy to Identify People With Prediabetes in a Large Workforce With Employer-Sponsored Health Insurance

“…Although more recent reports indicate that enrollment in the NDPP has increased substantially since 2015 ( 22 , 23 ), additional interventions will be needed to increase provider awareness of prediabetes and facilitate communication of risk to patients with prediabetes. The American Medical Association and the YMCA of the U.S. have developed tools and tested the feasibility of establishing clinical–community linkages to facilitate the systematic identification of patients with prediabetes and their referral to NDPPs at YMCAs ( 8 ). Such population-level strategies will be required to expand the reach and uptake of targeted NDPPs to address the global epidemic of type 2 diabetes.…”

“…The 1-year NDPP requires at least 16 sessions during the first 6 months and monthly sessions thereafter. Finally, the pay-for-performance reimbursement model used for the NDPP may deter NDPP suppliers from enrolling candidates whom they feel might not adhere to the program ( 8 ).…”