An estimated 86 million Americans have prediabetes and 90% don't know it. The initiative announced yesterday seeks to reach this population and intervene before the disease progresses to type 2 diabetes mellitus, which costs $245 billion a year.
The president of the American Medical Association (AMA) and the director of CDC’s Division of Diabetes Translation yesterday announced a long-term initiative of screening for prediabetes and interventions to stop its progression, which they hope will halt the rise of cases of type 2 diabetes mellitus (T2DM), which threatens to affect 1 of 3 Americans.
Diabetes STAT—which stands for Screen, Test, Act Today—expands upon current efforts by the AMA, CDC and partners like the YMCA to reach those with prediabetes. In a briefing with reporters yesterday, AMA President Robert M. Wah, MD, and CDC’s Ann Albright, PhD, RD, outlined the effort to engage physicians, employers, commercial insurers, CMS, and even the food industry in the cause.
They described the effort as improving “linkages” among all those who play a role in preventing the disease. Albright was adamant that this could not be short-term, government-run fix with grant-based resources. “The time to act is now,” she said. “We need a national, concerted effort to prevent additional cases of type 2 diabetes, and we need it now.”
Persons with prediabetes have glycated hemoglobin (A1C) levels between 5.7 and 6.4 or fasting glucose between 100 and 125 but do not yet have full-blown T2DM. An estimated 86 million Americans have prediabetes but 90% of them don’t know it, a fact that makes it hard for physicians and public health officials to keep the numbers with T2DM from rising.
And the impact of diabetes is mounting. A study by the American Diabetes Association showed that the disease cost the United States $245 billion in 2012 in medical spending and lost productivity, and that number had grown by $71 million since 2007. “Our healthcare system simply cannot sustain the continued increases in the number of people developing diabetes,” Albright said. “Screening testing and referring people at risk for type 2 diabetes to evidence-based lifestyle change programs are critical to preventing or delaying new cases.”
Wah and Albright agreed that when persons with prediabetes are made aware of their diagnosis—especially by a physician—they typically do make lifestyle changes or take medication to get indicators like blood glucose under control. That’s why the outreach efforts to identify those at risk are essential.
Diabetes STAT calls for multiple stakeholders to invest resources in reaching those with prediabetes and halting the disease, first by identifying those at risk and then by putting them through prevention programs that will help patients modify their eating patterns and increase exercise for the long haul. A key component before this rollout, Albright said, has been working with commercial insurers, CMS, and major employers to convince them that paying for diabetes prevention programs is just as cost-effective as paying for medication—and perhaps more so. “You can out eat any medication,” she said. “It is imperative that we have a foundation of lifestyle change.”
Health plans and accountable care organizations (ACOs) will have incentives in the next few years to embrace diabetes prevention and control under the Affordable Care Act and recent announcements by CMS that value-based reimbursement is on the way. The agency that is the nation’s largest payer will require that 30% of Medicare payments be value-based by 2016 and 50% be value-based by 2018. Already, diabetes-related measures are among the population health ratings that ACOs must track in determining Medicare reimbursement under the Medicare Shared Savings Program.
The roots of yesterday’s launch have been in place for some time. In 2012, CDC launched the National Diabetes Prevention Program, and Albright said it has demonstrated success with 70% of those over age 60 who have participated. Now, she said, it’s time to reach many more people on a much bigger scale. Pilot projects in 4 states have given public health officials insights into the best way to connect the clinical care setting to the community centers that will deliver the education programs necessary to get people to permanently change what they eat and surround themselves with the support systems to stick with behavioral change once they complete a program.
Wah said the AMA’s role involves reaching physicians at every level to help them screen patients and then refer them to community centers, their local YMCA, or other places where they can gain access to the NDPP. A special website for physicians has been created as part of the initiative.
“Long term, we are confident that this important and necessary work will improve health outcomes and reduce the staggering burden associated with the public health epidemic of type 2 diabetes,” he said.
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