Efforts ongoing to prevent diabetes in vulnerable populations
Presenters: O. Kenrik Duru, MD, Gia E. Rutledge, MPH, and Yvette Roubideaux, MD, MPH
The challenges and opportunities of implementing the National Diabetes Prevention Program (DPP) in vulnerable populations was the focus of a special symposium.
The evidence to support the DPP within Medicaid is scant, said O. Kenrik Duru, MD, professor of medicine, University of California, Los Angeles. In California, a multisite research program is being undertaken to understand how well DPP coverage in Medi-Cal improves population health and to determine the effectiveness of mandated Medi-Cal DPP coverage on outcomes such as body weight, systolic blood pressure, incident type 2 diabetes, and projected cost savings among Medi-Cal beneficiaries with prediabetes.
As of January 2019, Medi-Cal DPP coverage became a California law under House Bill (HB) 97. An R18 research demonstration and dissemination project was awarded from the National Institutes of Diabetes and Digestive and Kidney Diseases to study the implementation of HB97. All Medi-Cal health plans must provide a DPP recognized by the U.S. Centers for Disease Control and Prevention to all interested and eligible beneficiaries with prediabetes. As of June 2021, three DPP suppliers are approved to bill California for Medi-Cal DPP services, and 29 other suppliers in Los Angeles County report having started the application process.
Under DP18-1815, CDC’s Division of Diabetes Translation (DDT) funds state and local health departments to support programs and activities to prevent or delay the onset of type 2 diabetes in high-burden populations and to improve health outcomes for people diagnosed with diabetes.
Based on recipient-reported data from September 30, 2018, to June 30, 2019, 4.7 million patients served within health care organizations have systems to identify people with prediabetes and refer them to CDC-recognized organizations, which is 66% of the 2023 target of 7 million patients, reported Gia E. Rutledge, MPH, lead health scientist, Performance Improvement and Evaluation at the CDC’s DDT. More than 2.2 million private employees and dependents, 1.4 million Medicaid beneficiaries, and 1.1 million state/public employees and dependents have the National DPP lifestyle change program as a covered benefit. About 374,000 participants have been enrolled in CDC-recognized lifestyle change programs.
Establishing or expanding the use of telehealth is one of the public health strategies to prevent and manage diabetes, heart disease, and stroke under DP18-1817, a 5-year cooperative agreement by the DDT to fund 21 state health departments, large city and county health departments, and a consortia of city and county health departments. At the latest report, 155 telehealth delivery sites have been established in underserved areas to increase access to the National DPP lifestyle change program.
Through September 2020, under DP17-1705, 27 new CDC-recognized organizations are offering the lifestyle change program in underserved areas, and more than 7,000 participants in underserved areas have been enrolled in the lifestyle change program with cooperative agreement funds.
As of the first quarter of 2021, 1,858 CDC-recognized organizations overall are offering the National DPP lifestyle change program and 515,258 participants have been enrolled. A total of 695 organizations have achieved the program’s average weight loss goal of 5%. Eighteen states now offer the lifestyle change program as a covered benefit.
The Special Diabetes Program for Indians (SDPI),1 which provides grants to prevent and treat diabetes in American Indians and Alaskan natives and administered by the Indian Health Services, has helped to achieve progress in access to dietitians, physical activity specialists, adult weight management services, and nutrition services in children since its inception in 1997, said Yvette Roubideaux, MD, MPH, vice president for research, National Congress of American Indians.
As a result, glucose control and other diabetes-related outcomes have improved markedly in these populations. For example, average blood sugar has decreased by 10%, and average level of low-density lipoprotein cholesterol has decreased by 24%.1 “Blood pressure has been well controlled overall for more than 20 years,”1 she said. The rate of hospitalizations for uncontrolled diabetes has decreased by 84%, and the incidence of kidney failure has decreased by 54% in American Indians and Alaskan native adults, and diabetes prevalence is now decreasing.1 Diabetes-related mortality has decreased by 37%.1
“There’s ample evidence that the SDPI increases access to quality diabetes . . . and this increased access to care really has made a difference,” said Dr. Roubideaux.
Despite the progress in outcomes, disparities still exist. The age-adjusted estimated prevalence of diagnosed diabetes remains higher in American Indians/Alaskan Natives than other groups based on race/ethnicity. “We cannot just rely on the SDPI to eliminate all of this disparity. We need to address the social determinants of health, and in addition to the efforts of the health system, solutions in the community are needed, and that’s what the SDPI taught us,” she said.
References
Disclosures
Dr. Duru has nothing to disclose.
Dr. Rutledge has nothing to disclose.
Dr. Roubideaux has nothing to disclose.