Public Health Approaches to Type 2 Diabetes Prevention: the US National Diabetes Prevention Program and Beyond

Gruss, Stephanie; Nhim, Kunthea; Gregg, Edward W.; Bell, Miriam; Luman, Elizabeth T.; Albright, Ann

doi:10.1007/s11892-019-1200-z

Cited by 118 publications

(108 citation statements)

References 47 publications

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“…The prevalence of obesity and metabolic diseases has been increasing over the last decades, and a complex interaction between multiple environmental and genetic factors might explain this trend [1]. Remarkably, there is mounting evidence that several metabolic adult-onset conditions, such as metabolic syndrome, type 2 diabetes (T2D) and cardiovascular diseases (CVD), might take roots in a hostile intrauterine environment related to an unfavourable maternal diet or lifestyle [2].…”

Section: Introductionmentioning

confidence: 99%

Bisphenol A and Phthalates in Diet: An Emerging Link with Pregnancy Complications

et al. 2020

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Endocrine-disrupting chemicals (EDCs) are exogenous substances that are able to interfere with hormone action, likely contributing to the development of several endocrine and metabolic diseases. Among them, Bisphenol A (BPA) and phthalates contaminate food and water and have been largely studied as obesogenic agents. They might contribute to weight gain, insulin resistance and pancreatic β-cell dysfunction in pregnancy, potentially playing a role in the development of pregnancy complications, such as gestational diabetes mellitus (GDM), and adverse outcomes. Pregnancy and childhood are sensitive windows of susceptibility, and, although with not univocal results, preclinical and clinical studies have suggested that exposure to BPA and phthalates at these stages of life might have an impact on the development of metabolic diseases even many years later. The molecular mechanisms underlying this association are largely unknown, but adipocyte and pancreatic β-cell dysfunction are suspected to be involved. Remarkably, transgenerational damage has been observed, which might be explained by epigenetic changes. Further research is needed to address knowledge gaps and to provide preventive measure to limit health risks connected with exposure to EDCs.

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Section: Introductionmentioning

confidence: 99%

Bisphenol A and Phthalates in Diet: An Emerging Link with Pregnancy Complications

et al. 2020

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“…A challenge is that men and younger individuals are underrepresented in the NDPP, and additional participation gaps exist for priority populations. In a 2019 CDC report, only 24.7% of NDPP participants were men, 10 despite their higher prevalence of prediabetes compared to women (37.4% vs. 29.2%). 1 There may also be a missed opportunity for lifelong diabetes prevention among the 28.7 million US adults under age 45 with prediabetes, 1 as the average age of participants is 55.1.…”

Section: Addressing Disparities In Reachmentioning

confidence: 97%

“…In turn, population reach has been fast increasing from about 35,000 eligible participants served as of 2016 3 to over 324,000 by early 2019. 10 Whereas the inherently limited capacity of in-person sites might cap potential growth, online and distance learning models have also been approved by the CDC since 2015 and 2018, respectively, 10 with more limitless potential to expand reach. Indeed, despite fewer online than in-person NDPP suppliers 7 and later approval for dissemination, online delivery exceeds the reach of in-person programs.…”

Section: Successes With Reachmentioning

confidence: 99%

“…Indeed, despite fewer online than in-person NDPP suppliers 7 and later approval for dissemination, online delivery exceeds the reach of in-person programs. 10 Such virtual delivery can also ensure wide geographic reach to fill the many gaps where in-person sites are unavailable. 11,12 Overcoming Challenges with Reach…”

Section: Successes With Reachmentioning

confidence: 99%

“…Nearly three-quarters of participants (71.7%) do not achieve the ≥5% weight loss goal according to a CDC report. 10 Of further concern, disparately low weight loss is observed for women, younger adults, and racial/ethnic minority and low-income participants, who lose about half as much weight as their counterparts. 3,21,37 Improving retention appears key overall to ensuring beneficial weight loss outcomes (e.g., each session attended is associated with 0.3% more weight loss).…”

Section: Successes With Effective Implementationmentioning

confidence: 99%

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

Ritchie¹,

Baucom²,

Sauder³

2020

DMSO

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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.

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Associations of Intensive Lifestyle Intervention in Type 2 Diabetes With Health Care Use, Spending, and Disability

et al. 2020

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IMPORTANCE Intensive lifestyle interventions focused on diet and exercise can reduce weight and improve diabetes management. However, the long-term effects on health care use and spending are unclear, especially for public payers. OBJECTIVE To estimate the association of effective intensive lifestyle intervention for weight loss with long-term health care use and Medicare spending. DESIGN, SETTING, AND PARTICIPANTS This ancillary study used data from the Look AHEAD randomized clinical trial, which randomized participants with type 2 diabetes to an intensive lifestyle intervention or control group (ie, diabetes support and education), provided ongoing intervention from 2001 to 2012, and demonstrated improved diabetes management and reduced health care costs during the intervention. This study compared Medicare data between study arms from 2012 to 2015 to determine whether the intervention was associated with persistent reductions in health care spending. EXPOSURE Starting in 2001, Look AHEAD's intervention group participated in sessions with lifestyle counselors, dieticians, exercise specialists, and behavioral therapists with the goal of reducing weight 7% in the first year. Sessions occurred weekly in the first 6 months of the intervention and decreased over the intervention period. The controls participated in periodic group education sessions that occurred 3 times per year in the first year and decreased to 1 time per year later in the trial. MAIN OUTCOMES AND MEASURES Outcomes included total Medicare spending, Part D prescription drug costs, Part A and Part B Medicare spending, hospital admissions, emergency department visits, and disability-related Medicare eligibility. RESULTS This study matched Medicare administrative records for 2796 Look AHEAD study participants (54% of 5145 participants initially randomized and 86% of 3246 participants consenting to linkages). Linked intervention and control participants were of a similar age (mean [SD] age, 59.6 [5.4] years vs 59.6 [5.5] years at randomization) and sex (818 [58.1%] women vs 822 [59.3%] women). There was no statistically significant difference in total Medicare spending between groups

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Public Health Approaches to Type 2 Diabetes Prevention: the US National Diabetes Prevention Program and Beyond

Cited by 118 publications

References 47 publications

Bisphenol A and Phthalates in Diet: An Emerging Link with Pregnancy Complications

Bisphenol A and Phthalates in Diet: An Emerging Link with Pregnancy Complications

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

Associations of Intensive Lifestyle Intervention in Type 2 Diabetes With Health Care Use, Spending, and Disability

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