Briefing addresses methods to combat growing prediabetes incidence

Current and future strategies in the fight against prediabetes were the focus of a briefing in Washington, D.C., that featured experts at major U.S. federal and medical institutions and organizations.

Winston F. Wong, MD, director of disparities improvement and quality initiatives at Kaiser Permanente, discussed ethnic, social and racial dissimilarities in diabetes and prediabetes prevalence and said there is a shift in attitude toward the treatment of minorities.

“We need to hit a sweet spot in regard to accelerating effective therapy among people with prediabetes and diabetes and do it in a way that engages communities and people who have different expectations of what they get out of the health care system,” such as people who do not speak English, Wong said.

Agency efforts

Ann Albright, PhD, director of the CDC division of diabetes translation, discussed the future of the Diabetes Prevention Program, which will be expanded across the United States to help reduce the rising number of patients with prediabetes and diabetes.

“It is critically important that the interventions we develop are those that can apply to more than one segment of the population,” Albright said at the briefing. “Attendance matters. People need to participate, and it is important to make this available to people in locations where that is possible.”

In an attempt to bolster the program, organizers will focus their efforts on several specific areas of expansion: the creation of training centers; fostering a sense of transparency; attracting high-risk patients; and initiation of intervention sites to be turned over to third party payers (such as UnitedHealth Group, which has signed on to take over the program at the YMCA).

The program will cost about $300 per participant annually, a price that Albright said will, in the long run, allow for cost savings.

Julie Paradis, administrator for food and nutrition services at the U.S. Department of Agriculture, outlined the agency’s current and future efforts. She said the passing of a robust childhood nutrition act is needed to improve the health and well-being of U.S. youth.

“It is far and away our best opportunity to make a positive impact on childhood obesity during the next 5 years,” Paradis said.

She discussed several soon-to-be-implemented improvements in school nutrition, including the reduction of barriers preventing children from participating in nutrition programs; improving meal quality; increasing school reimbursement; expanding direct certification to make more children eligible for free or reduced-price meals; diversifying school breakfast and summer food service programs; providing school meal report card to parents to help them guide their child’s food choices; and forging a stronger farm-to-school link to help local produce providers.

Beyond school program goals, Paradis spoke of other goals within the department, such as chefs working within their communities; implementation of the Healthy Food Financing Initiative to improve healthy food choices in supermarkets; and the growth of teen nutrition programs to encourage lifelong eating and physical activity habits.

The administration proposed an investment of $10 billion during the next 10 years to improve childhood nutrition programs.

“We feel that we have an important role to play in starting children off to a healthy lifestyle through our domestic nutrition programs,” Paradis said.

HbA1c and prediabetes

David M. Kendall, MD, chief scientific and medical officer for the American Diabetes Association, discussed the increasing importance of HbA1c in the diagnosis of prediabetes.

“Adding [HbA1c testing] to our toolbox is critical,” he said at the briefing.

Kendall said the HbA1c assay will be a useful part of the Medicare screening program, adding that the ADA is “in discussions not only with payers but providers, including the federal government at the [CMS] and others to talk about the potential utility of HbA1c.” – by Matthew Brannon

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