The Key Principles and Levers of the DPP



The National Diabetes Prevention Program (DPP) was created with the goal of reducing the incidence of type 2 diabetes in high-risk persons in the United States; the DPP plans on realizing this goal by collaborating with community-based organizations, health payers, public health services, academia and others who are willing to tackle this task with them. Ann L. Albright, PhD, RD, Director, Division of Diabetes Translation at the Centers for Disease Control and Prevention (CDC), speaking today at the American Diabetes Association’s 70 Scientific Sessions during her session “Building a Public Health Infrastructure for Behavior Change,” said the DPP is built on four principles and will operate by virtue of four levers.

The first principle of the DPP is that diabetes risk must match the program’s cost. The current annual risk is 50%, while the annual rate for adults is 1% and the rate from “birth to death” is 33%. “Ever hear 1 in 3?” Dr. Albright said. “We’re not just whistling Dixie folks.”

The program must also be effective, Dr. Albright continued. She presented data that showed the comparison between those given a placebo, those taking metformin, and those participating in the DPP lifestyle intervention program. The annual incidence of diabetes for the placebo group was 11.0%, the metformin group 7.8%, and the lifestyle intervention was 4.8%. When compared with placebo the relative reduction for metformin was 31% and the lifestyle intervention checked in at 58%. And when looking at the literature, 13 studies have translated the DPP and subjects attended anywhere from 6 to 16 educational sessions and have achieved weight loss levels of between 2.7% to 6%; the more sessions that were attended the more weight was lost.

The third principle of the DPP is that the program must be economically sustainable. To illustrate how it has done this thus far, Dr. Albright presented data from the DPP Lifestyle Benefit. The benefit consisted of 100 people for a duration of 3 years. During those 3 years, the DPP prevented 15 new cases of diabetes, 162 missed work days, and helped 16 people avoid the need for blood pressure and cholesterol medicine, among other positive results. According to Dr. Albright, the lifestyle intervention should cost $300 per person in order to save money.

But maybe the most important principle is that the program must be available. Dr. Albright noted that the program can be as effective as possible, but if no one can make it to a center to take part, then the effectiveness doesn’t matter. The CDC is currently working to ensure that as many people as possible have access to a place where they can participate in the DPP. They are currently operating the program in YMCAs, which makes it available to a large number of people since there are 2,686 YMCAs in the U.S. and 57% of households in this country are located within 3 miles of one. But they are not solely going to be in YMCAs, the Y just got on board with the programs quickly; the CDC is planning on expanding the program into more community centers across the country.

While the program is built on these core principles, it consists of four key levers. The first is to train a work force that can implement the program cost effectively. Second, they must implement a recognition program that contributes to assuring quality, leads to reimbursement, and enables the CDC to develop a registry of programs for public reporting; the recognition program is currently under devlopment with the final draft expected in September. Next, they must implement sites that will build the infrastructure and some that will provide a “laboratory” for further refinement of the prevention program. And finally, increasing referrals and the utilization of the prevention program through health marketing and other developed strategies.

This is the plan for the DPP to grow and allow itself to make an impact on as many lives as possible. Simply establishing the program isn’t enough Dr. Albright said, “Just because you build it doesn’t mean people will come.” And despite the challenges that are ahead, Dr. Albright remains positive.

“It’s an exciting time for primary prevention,” she said.

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