Progress continues with the National Diabetes Prevention Program

SAN DIEGO — The National Diabetes Prevention Program has been making great strides in preventing and delaying type 2 diabetes, but work still remains, according to Brenda Montgomery, RN, MSHS, CDE.

Montgomery, president of Health Care and Education for the American Diabetes Association, described the three pillars of diabetes prevention — driving discovery, raising voices and supporting the people — during the Health Care and Education Address here.

“The research partnerships and innovation on a global scale drive discovery to prevent, manage and ultimately cure diabetes,” Montgomery said. “We need to intensify the urgency around the diabetes epidemic and mobilize bold action through advocacy and engagement. We also need to provide new effective resources for individuals living with and at risk for developing diabetes and for the health care professionals supporting them.”

Under the first pillar, Drive Discovery, the ADA backed advocacy for the Diabetes Prevention Act and collaborated with the YMCA to support establishment and funding of the National Diabetes Prevention Program (NDPP).

“There’s been huge progress in our understanding of prevention since 1993 when the NDPP was originally designed,” Montgomery said. “Small steps, big rewards — it’s a common phrase used in the DPP, and the follow-on DPP-OS study stressed how modest change can make a difference. We now use it when discussing the pillars of prevention and changing the world.”

Since the original implementation of the NDPP, numerous studies have shown how lifestyle interventions and metformin compared with placebo are highly effective in reducing the risk for type 2 diabetes.

According to Montgomery, the DPP “continues, to this day, to bear fruit,” and over 30 papers have been published in the past 4 years.

Under the pillar Raise Voice, the ADA backed advocacy for the Diabetes Prevention Act, legislation to establish an NDPP at the CDC. Language establishing the NDPP passed Congress as part of the Patient Protection and Affordable Care Act in 2010.

In 2011, work was done to capitalize on the success experienced by older adults who participated in the DPP clinical trial. The risk for developing diabetes in this age group was reduced by more than 70%. The ADA worked with senators to introduce the Medicare Diabetes Prevention Act, which would require Medicare to cover participation in an NDPP program for Medicare beneficiaries with prediabetes. In July 2016, it was announced that Medicare would take steps to cover the NDPP for older adults at high risk for diabetes.

“This was a groundbreaking achievement following the many years of advocacy,” Montgomery said. “In November 2016, CMS released a final rule declaring Medicare coverage of DPP would begin in January 2018. The announcement was a huge victory.”

Montgomery added that 50% of Medicare beneficiaries have prediabetes and 1 out of 3 Medicare dollars is spent caring for someone 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.”

But, Montgomery added, work is still needed to establish prevention for other populations, particularly in regard to metformin use.

“Metformin is particularly effective in younger people, the morbidly obese and women with a history of gestational diabetes,” she said.

However, only 3.7% of patients with prediabetes were prescribed metformin over 3 years in a national sample of over 17,000 working age adults between 2010 and 2012, Montgomery said.

“Low prescription rates may be due to lack of indication. As it’s a generic medication, no one is clamoring to invest in the work involved to change the label or indication,” Montgomery said. “We now need to get metformin approved as a treatment for the prevention [of diabetes]. The ADA along with [the American Association of Clinical Endocrinologists], the Endocrine Society, the DPP researchers and other experts, initiated a citizen’s petition process to create an indication for metformin in prediabetes.”

According to Montgomery, evidence to support the petition was presented to the FDA in September 2016, when the FDA requested more data, and the DPP investigators are expected to present those data in the near future.

Under the final pillar, Support People, Montgomery noted that there is an increasing need for prevention in children as type 2 diabetes diagnoses continue to rise.

“We now need to mobilize significant efforts to reduce or delay type 2 diabetes in children,” she said. “Please join me and the ADA in our prevention efforts. Now is the time to take larger, louder steps, and we better start running.” – by Amber Cox

Reference:

Montgomery B. HCE-01. Presented at: American Diabetes Association 77th Scientific Sessions; June 9-13, 2017; San Diego.

Disclosures: Montgomery reports being an employee of AstraZeneca.