Diabetes, Metabolic Syndrome and Obesity (Aug 2020)
Current Perspectives on the Impact of the National Diabetes Prevention Program: Building on Successes and Overcoming Challenges
Abstract
Natalie D Ritchie,1– 3 Katherine JW Baucom,4 Katherine A Sauder5,6 1Ambulatory Care Services, Denver Health and Hospital Authority, Denver, CO, USA; 2Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA; 3University of Colorado College of Nursing, Aurora, CO, USA; 4Department of Psychology, University of Utah, Salt Lake City, UT, USA; 5Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA; 6Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado, Aurora, CO, USACorrespondence: Natalie D RitchieDenver Health and Hospital Authority Email [email protected]: To address the public health and economic burden of type 2 diabetes, the Centers for Disease Control and Prevention (CDC) began dissemination of the National Diabetes Prevention Program (NDPP) in the United States in 2010. Based on the intensive lifestyle intervention from a large efficacy trial, the NDPP aims to reduce incidence through lifestyle change and weight loss. This narrative review summarizes evidence on reach, effectiveness, and sustainability of the NDPP, while highlighting opportunities to overcome challenges in these areas. Major successes include reaching hundreds of thousands of at-risk individuals across the nation, with notable effectiveness upon full participation and widespread insurance coverage. Yet, more work is needed to ensure greater public health impact, particularly among priority populations at heightened risk who also experience disparities in program outcomes. Preliminary evidence suggests a number of strategies may improve reach and effectiveness of the NDPP, often with more rigorous study needed prior to widespread uptake. Updating the NDPP to better match the current evidence-base may also be important, such as directly targeting glycemia with a patient-centered approach and promoting metformin as an adjunct or second-line treatment. Finally, revisiting pay-for-performance reimbursement models may be critical to sustainability by ensuring adequate availability of suppliers and ultimately reducing diabetes prevalence.Keywords: obesity, type 2 diabetes mellitus, prediabetes, lifestyle modification, prevention
