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Few At-Risk Adults Are Being Referred to Diabetes Prevention Programs, Study Finds


The CDC created the National Diabetes Prevention Program following a study of a lifestyle intervention; new results show that more than a third of adults who are referred to a program take part, but only a fraction are referred.

Despite the evidence that shows diabetes prevention programs work, few at-risk adults find their way to them, researchers from Johns Hopkins report in a new study.

The study used data from the 2016 National Health Interview Study and reported results in the March issue of the American Journal of Preventive Medicine. “For certain individuals, type 2 diabetes can be prevented or delayed through diet and exercise, and the National Diabetes Prevention Program’s lifestyle intervention is one evidence-based method to help people at high risk to do so,” lead author Maya Venkataramani, MD, MPH, said in a statement.

“Our research highlights the importance of continued efforts to enhance the reach of this program,” said Venkataramani, an assistant professor of medicine at the university’s medical school.

The CDC reports that 30 million adults have type 2 diabetes (T2D), which means the body does not properly use insulin to keep blood sugar at normal levels. When blood sugar remains elevated over long periods of time, complications such as kidney failure, blindness, amputations, and cardiovascular disease occur. Diabetes is the seventh leading cause of death in the United States.

Those who have elevated blood sugar but have not progressed to T2D have a condition called prediabetes, which means they are at risk of developing diabetes. This group has elevated blood glucose between 100 and 125 mg/dL, even after fasting, or glycated hemoglobin of 5.7% to 6.4%. This condition affects 84 million people in the United States, and most don’t know it.

The failure to connect adults whose health indicators show they are likely to develop type 2 diabetes (T2D) to the evidence-based lifestyle interventions, including the National DPP, means that health plans including Medicare will face higher costs in the future. Already, the cost burden of diabetes to the United States—most of it from T2D—is $327 billion a year in healthcare and lost productivity, according to a study by the American Diabetes Association.

CDC created the National Diabetes Prevention Program (DPP) in 2010, based on research of a lifestyle intervention conducted by the National Institutes of Health that appeared in the New England Journal of Medicine in 2002. To promote the National DPP, CDC later launched a partnership with the American Medical Association that featured an online prediabetes screening test to raise awareness of the National DPP among primary care physicians and boost referrals.

Last year, CMS began covering seniors in the Medicare DPP, although there is no reimbursement for online versions of the program, which critics have said limits access to seniors in rural areas where rates of prediabetes are higher.

The Johns Hopkins study captured a snapshot of the DPP before Medicare’s effort began, but when community programs were well-established. Researchers analyzed responses to diabetes primary prevention questions asked to 28,354 adults from across the United States, which contained self-reported information on referrals, participation, and interest in the DPP. The study team focused on answers from 2341 respondents who were eligible for the program. Of this group, 63% were female, and 70% were 45 years or older. About 75% were white, 14.4% were black, and 6.7% were Asian.

More than 25% of eligible adults said they were interested in taking part in the DPP, but only 4.2% said their clinicians had made a referral. More than a third of the referred adults took part in the program, but only 2.4% of eligible adults participated either after being referred by a doctor or after learning about the DPP on their own.

Likely participants were older and had lower incomes. African American and Asian adults were more likely to say they’d been referred to the program. “These are groups that historically have poorer access to preventive services,” Venkataramani said. “They have a higher burden of diabetes-related complications. It is thus important to confirm these trends, and if they hold, understand the reasons behind enhanced referral, participation, and retention.”

But the low participation rates show the need to build awareness among both clinicians and the public, the researchers say.


Venkataramani M, Pollack CE, Yeah HC, Maruthur NM. Prevalence and correlates of diabetes prevention program referral and participation. Am J Preven Med. 2019;56(3):335-342. doi: 10.1016/j.amepre.2018.10.005.

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