The Diabetes Prevention Program (DPP) started in 1996, but its benefits continue to improve the lives of those with diabetes and prediabetes, according to Brenda Montgomery, RN, MSHS, CDE, ADA President, Health Care & Education.
During her presidential address Saturday morning at the Scientific Sessions, Montgomery discussed how the DPP changed the diabetes world and how the ADA, based on the findings of the DPP, stepped in to support, disseminate, and advocate on behalf of the diabetes prevention.
“I know that most of you are here at the Scientific Sessions to hear about the latest science, yet there are many aspects of the ADA that perhaps you’re less aware of,” she said. “I want to shout from the mountains, honestly, how proud I am of the advocacy work of the ADA.”
Montgomery was one of the early participants in the DPP, which worked to recruit people who were disproportionately affected by diabetes—older people, women, and ethnic minorities.
Early DPP results found that lifestyle changes reduced diabetes risk by 58 percent compared with placebo, and metformin reduced risk by 31 percent compared to placebo. Data from the 15-year follow-up showed risk reduction at 27 percent and 18 percent, respectively.
The DPP and the Diabetes Prevention Program Outcomes Study (DPPOS), which assesses the long-term impact of DPP interventions, have attracted a lot of scientific interest and cultivated a model of collaboration, Montgomery said. The DPP continues to bear fruit, she added, with 30 papers using DPP data published in the last four years.
First translated to the real world through YMCA wellness instructors in Indianapolis and then around the country, the DPP model has since expanded nationally and internationally. Montgomery cited a meta-analysis of 28 programs modeled on the DPP focusing on weight loss that found that study subjects experienced weight loss regardless of the medical specialty of the person delivering the intervention.
In 2009, the ADA and the YMCA pushed for congressional approval of the Diabetes Prevention Act, an effort to establish a diabetes prevention program with the Centers for Disease Control and Prevention for those at high risk for diabetes. It passed in 2010 as part of the Affordable Care Act.
Bolstered by a study that found that seniors in a DPP clinical trial reduced their diabetes risk by more than 70 percent, the Medicare Diabetes Prevention Act was born. The act would require Medicare to cover participation in a national DPP program. The Centers for Medicare & Medicaid Services has since said that Medicare coverage would begin in January 2018.
“This is a huge victory,” Montgomery said. “Fifty percent of Medicare beneficiaries have prediabetes, and one out of three Medicare dollars is spent caring for somebody with diabetes. Because of our advocacy efforts, seniors will soon have access to evidence-based prevention programs that will not only improve their health, but will bring down Medicare costs as well. Prevention is going to explode.”
Work has now started on getting metformin approved for prediabetes. The ADA also supports access and choice for women who have had gestational diabetes to select the evidence-based medication that’s best for them.
“There’s been huge progress in our understanding of preventions since 1993 when the DPP was initially designed,” Montgomery said. “‘Small steps, big rewards.’ It’s a common phrase used in the DPP and the follow-up DPPOS about how modest change can make a big difference.”