Social and Policy Solutions to Prevent and Manage Diabetes

1. Social and Policy Solutions to Prevent and Manage Diabetes Ann Albright, PhD, RD Director, Division of Diabetes Translation Centers for Disease Control and Prevention

2. DISTRIBUTION AVAILABILITY Diffusion of interventions EFFICIENCY Supply EFFECTIVENESS Biggest effect on most people EFFICACY Real world settings BASIC SCIENCE Ideal settings Molecular/ physiological POLICY POLICY POLICY

3. Ecological Model Community and policy System, group, culture Family, friends, small group Individual The health of individuals is inseparable from the health of communities (Healthy People 2010)

4. Prevention of Type 2 DiabetesThe Community – Clinic Partnership Model Community Clinic Insurers Partnership Zone } Employers Proactive Practice Team Reimbursement Screening for High Risk Informed Population Diagnosis of Prediabetes Decision Support Strong Community Organizations Structured Lifestyle Programs Information Systems Healthy Public Policy Informed, Activated Patients Regular Glucose Monitoring Supportive Environments Total Population Complications Pre-diabetes Diabetes

5. NEXT-D Study • Public health efforts to reduce diabetes impact have included an array of policies aimed at promoting preventive health behaviors, improving access and quality of care, and reducing disparities • These include diverse policy initiatives by health plans, employers, communities, and legislative bodies at local, state, and federal levels • These innovations have diverse mechanisms of actions - reimbursement (i.e. benefit) structure, pricing, food and product labeling, employer-based approaches, and economic incentives and disincentives.

6. NEXT-D Study • Unfortunately, most system- and macro-level policy innovations go untested or thoroughly evaluated, particularly if they emanate from outside the clinical encounter • The unabated increases in obesity, diabetes, and cardiometabolic disease indicate a need to identify and prioritize system- and policy-level “best practices” • A new multi-center research infrastructure and platform has been developed to assess the impact of naturally occurring innovations in health policy, system change, and health-related legislation on preventive care and behaviors to reduce diabetes risk in the population

7. NEXT-D is Evaluating • Impact of employer-mandated high deductible health plans on diabetes outcomes • Health plan coverage of community-based diabetes prevention program • Effectiveness of employer-based detection, outreach, and incentives for prevention of diabetes and post-partum glucose screening • Use of electronic medical records with decision support on prediabetes and diabetes outcomes • Effectiveness of a health plan designed to reduce out-of-pocket costs

8. Critical Elements of Diabetes Management

9. Policy Efforts in State DPCPs • Reimbursement for DSME/CDSMP • Increasing sustainability of community health workers • Increasing role of allied health professionals in medical management of diabetes

10. DPP Research Study: Incidence of Diabetes Placebo (n=1082) Metformin (n=1073, p<0.001 vs. Placebo) Lifestyle (n=1079, p<0.001 vs. Metformin , p<0.001 vs. Placebo) Risk reduction 31% by metformin 58% by lifestyle The DPP Research Group, NEJM 346:393-403, 2002

11. Summary of Benefits of DPP Lifestyle Program • Treating 100 high risk adults (age 50) for 3 years… • Prevents 15 new cases of type 2 diabetes1 • Prevents 162 missed work days2 • Avoids the need for BP/Chol pills in 11 people3 • Adds the equivalent of 20 perfect years of health4 • Avoids $91,400 in healthcare costs5 1DPP Research Group. N Engl J Med. 2002 Feb 7;346(6):393-403 2 DPP Research Group. Diabetes Care. 2003 Sep;26(9):2693-4 3 Ratner, et al. 2005 Diabetes Care 28 (4), pp. 888-894 4 Herman, et al. 2005 Ann Intern Med 142 (5), pp. 323-32 5 Ackermann, et al. 2008 Am J Prev Med 35 (4), pp. 357-363; estimates scaled to 2008 $US

12. Cost of DPP 1-1 Format • First 12 months cost = $1,400 per participant • Total 3 year cost = $2,780 per participant • With inflation, three year costs of this program in 2010 exceed $3,500 per participant

13. Cost of Group-Based Format • $275 -$325 per participant when using trained Y staff (Ackermann, et al) • $550 per participant when using CDEs (Amundsen, et al) • About $500 per person when implementing to scale since it includes engaging participants, enrollment, managing eligibility, etc.

14. National Diabetes Prevention Program • Goal: • Systematically scale the translated model of the Diabetes Prevention Program (DPP) for high risk persons in collaboration with community-based organizations that have necessary infrastructure, health payers, health care professionals, public health, academia, and others to reduce the incidence of type 2 diabetes in the United States.

15. NATIONAL DIABETES PREVENTION PROGRAM Components Health Marketing: Support Program Uptake Increasereferrals to and use of the prevention program Intervention Sites: Deliver Program Develop intervention sites that will build infrastructure and provide the program Training: Increase Workforce Train the workforce that can implement the program cost effectively • Recognition Program: Quality • Implement a recognition program that will: • Assure quality • Lead to reimbursement • Allow CDC to develop a program registry

16. Resources and Media Contacts • Division of Diabetes Translation • www.cdc.gov/diabetes • National Diabetes Education Program • www.yourdiabetesinfo.org • Media Contacts • Email: media@cdc.gov • Phone: 404-639-3286