Many additional studies have been conducted on variations of the DPP intervention. One recent evaluation conducted by RTI international assessed a Y-USA implementation of the national DPP lifestyle change program.Cognitive learning definition the Y-USA received an $11M CMS health care innovation award to implement and evaluate the program with medicare beneficiaries in 17 YMCA locations.Cognitive learning definition the goals of the intervention were to support participants in losing at least 5% of their body weight and exercising 150 minutes per week. The participants received group coaching.Cognitive learning definition RTI found that in the first five quarters of the program, savings amounted to $2,636 per participant. Through the first 11 quarters, those attending at least one core session lost 3.8% of their body weight, and those attending at least four core sessions lost 4.5% of their body weight.Cognitive learning definition

A recent article in diabetes care analyzes data from the CDC’s diabetes prevention recognition program and concludes that greater duration and intensity of session attendance resulted in a higher percent of body weight loss overall and for subgroups.Cognitive learning definition focusing on retention may reduce disparities and improve overall program results. Further program expansion and investigation is needed to continue lowering the burden of type 2 diabetes nationally.Cognitive learning definition

To date there has been limited published data and analysis on the national DPP lifestyle change program in medicaid populations. Minnesota, montana, nevada and new york have received medicaid incentives for the prevention of chronic diseases (MIPCD) grants where a portion of the grant dollars funded incentives for national DPP lifestyle change program participants.Cognitive learning definition final evaluations of these programs may surface additional information about cost-effectiveness and health outcomes as it pertains to the national DPP lifestyle change program in medicaid.Cognitive learning definition

The center for evidence-based policy at OHSU produced a report in october 2017 discussing the long-term health effects of dietary and physical activity changes such as those used in the diabetes prevention program.Cognitive learning definition this report reviews the long-term effects of combined diet and physical activity focused lifestyle interventions on individuals with prediabetes or at high risk for diabetes.Cognitive learning definition the lifestyle interventions evaluated in this report either used the protocol from the diet and physical activity arm of the original diabetes prevention program (DPP) randomized controlled trial (RCT) (i.E., DPP intervention), or used a similar lifestyle intervention to the original DPP RCT diet and physical activity protocol (i.E., DPP-like intervention).Cognitive learning definition this report also includes an evaluation of the long-term effectiveness of variations in program delivery or population subgroups for DPP or DPP-like interventions.Cognitive learning definition

In march 2016, the CMS office of the actuary (OACT) released a certification report for expansion of the Y-USA national DPP lifestyle change program.Cognitive learning definition it reviewed results from the first two years of the Y-USA national DPP lifestyle change program implementation (referenced above), the original DPP clinical trial, and a subset of lifestyle change programs recognized by the CDC.Cognitive learning definition the report confirmed the results and certified that an expansion of DPP in the medicare population would reduce (or not increase) net-medicare spending.Cognitive learning definition

Diabetes has both serious health and economic consequences. These latest figures from the american diabetes association indicate direct and indirect estimated annual costs of $327 billion as a result of diabetes, individuals with diabetes face on average 2.3 times higher healthcare costs than those without diabetes, and 1 in 7 healthcare dollars are spent treating diabetes and its complications.Cognitive learning definition

In may 2016, the institute for clinical and economic review (ICER) released a draft evidence report, “diabetes prevention programs: effectiveness and value.” the report was subsequently finalized.Cognitive learning definition the report assessed 10 U.S. National DPP lifestyle change programs with full or pending recognition from the CDC’s diabetes prevention recognition program.Cognitive learning definition the report concluded that the programs (using in-person group coaching or an online format with a human coach) provided “an incremental or better” net health benefit.Cognitive learning definition it also concluded that online programs with fully automated (not human) coaching provided “comparable or better” net health benefit versus standard care.Cognitive learning definition

A study entitled “return on investment for digital behavioral counseling in patients with prediabetes and cardiovascular disease” looked at 2,371 individuals with prediabetes, and/or who were at risk for cardiovascular disease.Cognitive learning definition the participants enrolled in an online prevention program through omada health between 2012 and 2014 that exceeded the diabetes prevention recognition program (DPRP) standards.Cognitive learning definition the study used a markov-based model to simulate clinical and economic outcomes annually over 10 years using 26-week weight loss results from the program.Cognitive learning definition the simulated return-on-investment break-even point was 3 years for both populations, with a simulated five-year return on investment of $1,565 for the prediabetes population.Cognitive learning definition these findings suggest that online delivery of prevention programs can have a positive return on investment.

A review of the national DPP clinical trial was done from the perspective of resource utilization, costs of the interventions, costs of the non-intervention medical care, the impact of the interventions on diabetes progression and quality of life, and the cost-effectiveness of the interventions from health system and societal perspectives.Cognitive learning definition the data was analyzed over 3- and 10-year periods and indicated cost-efficacy and quality of life improvements for high-risk individuals.

A 2013 study of the long-term effects of diabetes prevention programs found that after ten years the intensive lifestyle intervention achieved a comparable positive long-term effect on cardiovascular disease risk factors as was seen in metformin and placebo groups.Cognitive learning definition A 23-year study of people with impaired glucose tolerance concluded that the cumulative incidence of cardiovascular disease mortality decreased from 19.6% in the control group to 11.9% in the group with a lifestyle intervention.Cognitive learning definition

A team of researchers evaluated the differences in health care costs between individuals with pre-diabetes who progress to type 2 diabetes, versus those that do not.Cognitive learning definition they found medical expenditures to be nearly one-third higher for those who develop diabetes, and indicate that lifestyle change programs such as the national DPP could yield positive net savings on medical care expenses and ROI.Cognitive learning definition

The community preventive services task force conducted a review of 53 studies (from january 1991 through february 2015) based on 66 combined diet and physical activity promotion programs.Cognitive learning definition the task force concluded that such interventions are cost-effective, and recommended diet and physical activity promotion programs for individuals at increased risk for developing type 2 diabetes.Cognitive learning definition it made this recommendation based on “strong evidence of effectiveness in reducing new-onset diabetes.”

The united states preventive services task force (USPSTF) is an independent panel of experts that publishes recommendations for evidence-based clinical preventive services.Cognitive learning definition the affordable care act requires a subset of health plans to cover items and services with a grade A or B USPSTF recommendation without cost-sharing for the relevant member.Cognitive learning definition the counseling requirements for abnormal blood glucose, healthful diet and physical activity, gestational diabetes, and obesity can be met through coverage of the national DPP lifestyle change program.Cognitive learning definition these recommendations will bring additional attention to prediabetes and may create momentum around the development of prediabetes measures.Cognitive learning definition

Several studies have found that lifestyle intervention programs can reduce the risk of cardiovascular disease. For example, a 2005 randomized clinical trial found that an intensive lifestyle intervention designed to achieve and maintain a 7% weight loss and 150 minutes of exercise per week decreased the incidence of metabolic syndrome (i.E., increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels that occur together) by 41%.Cognitive learning definition

Another benefit of the national DPP lifestyle change program is the reduction of sleep apnea. A study of obese adults with type 2 diabetes and obstructive sleep apnea found that over four years, intensive lifestyle intervention produced greater reductions in weight and sleep apnea than diabetes support and education only.Cognitive learning definition an analysis of two systematic reviews and eight randomized control trials of overweight or obese individuals who had obstructive sleep apnea also found that intensive lifestyle interventions resulted in significant weight loss and reduction in sleep apnea severity.Cognitive learning definition similarly, a systematic review and meta-analysis of 12 controlled trials found that intensive lifestyle management can significantly reduce obesity indices and decrease the severity of sleep apnea.Cognitive learning definition

The national DPP lifestyle change program can also improve general health, physical function, reduce bodily pain, and improve vitality scores on a health survey after three years.Cognitive learning definition similarly, another study concluded that weight loss because of the national DPP lifestyle change program was associated with improvements in measures of health-related quality of life.Cognitive learning definition finally, a study of a work place diabetes prevention lifestyle change program found improved metabolic and behavioral risk factors among employees with prediabetes.Cognitive learning definition

Holy rosary healthcare collaborated with the montana department of public health and human services to compare the participation, diet monitoring, physical activity, and weight loss of participants receiving the national DPP lifestyle change program in-person and participants receiving the program through telehealth.Cognitive learning definition using a distance learning approach, the telehealth participants were able to see and communicate with the lifestyle coaches and on-site participants in real-time.Cognitive learning definition the study, which included 894 program participants between 2008 and 2015, found that there were no statistically significant differences in the number of sessions attended, the mean weight loss, or the reduction in BMI between the in-person participants and the telehealth participants.Cognitive learning definition there were also no statistically significant differences in the percentage of participants who achieved ≥5% weight loss or the 7% weight loss goal.Cognitive learning definition these findings suggest that providing the national DPP lifestyle change program through distance learning and telehealth is equally effective in encouraging participation and weight loss as providing the program in-person.Cognitive learning definition

Omada offers an online version of the national DPP lifestyle change program where each participant receives a wireless scale, is part of a 10 to15 person virtual group, and has an assigned health coach.Cognitive learning definition A two-year study found that the 155 individuals who completed the program lost a mean 4.9% of their baseline body weight after one year and 4.3% after two years.Cognitive learning definition individuals who completed the program also had reduced a1c levels by 0.40% after year one and 0.46% after two years.

A non-randomized trial of patients who participated in the national DPP lifestyle change program through online delivery, related patient engagement during the first year to sustained weight loss after three years.Cognitive learning definition the trial found that participants who participated in four or more lessons during the first year sustained -3.0% weight loss after three years.Cognitive learning definition participants who participated in nine or more lessons during the first year sustained -2.9% weight loss after three years.

Researchers collaborated with omada to determine the feasibility of adapting online delivery of the national DPP lifestyle change program for low-income and hispanic patients.Cognitive learning definition the researchers used focus group feedback to adapt the curriculum to a 5th-grade reading level, adapt content to be culturally appropriate, and create a spanish version of the curriculum.Cognitive learning definition the low-income and hispanic populations displayed high engagement and satisfaction with the revised programs.

An observational study found that individuals in the medicare population who were willing to attempt to use an online version of the national DPP lifestyle change program were able to meaningfully engage with it.Cognitive learning definition participants lost 7.5% of their body weight at 12 months. While this study is not generalizable to the entire population of older adults, it provides evidence that online delivery of the national DPP can be successful for older populations.Cognitive learning definition

Canary health pilot tested an online version of the national DPP lifestyle change program that was delivered using audio-narrated lessons. The program included e-mail prompts, automated weekly progress reports, and as-needed communication with a lifestyle coach.Cognitive learning definition out of 50 pilot participants, 45 completed the program. Individuals who completed the program lost an average of 4.79 kg and systolic blood pressure dropped an average of 7.33 mm hg.Cognitive learning definition

Canary health pilot tested an online version of the national DPP lifestyle change program that was delivered using audio-narrated lessons. The program included e-mail prompts, automated weekly progress reports, and as-needed communication with a lifestyle coach.Cognitive learning definition out of 50 pilot participants, 45 completed the program. Individuals who completed the program lost an average of 4.79 kg and systolic blood pressure dropped an average of 7.33 mm hg.Cognitive learning definition