An ounce of prevention is worth a pound of cure: considerations for pharmacists delivering the National Diabetes Prevention Program
Prediabetes is highly prevalent in the United States affecting over 88 million adults. In 2010, the Centers for Disease Control and Prevention (CDC) established the National Diabetes Prevention Program (NDPP), an intensive lifestyle program consisting of a 16-lesson curriculum focused on diet, exercise, and behavior modification, with the ultimate goal to reduce progression from prediabetes to diabetes. Despite tens of millions of adults potentially qualifying to participate in the program, the uptake of the NDPP has been exceedingly low. As a result, the CDC has focused its efforts on engaging with local health departments and community partners, including community pharmacies, across the United States to scale-up enrollment in the NDPP. In this commentary we discuss factors affecting implementation of the NDPP in community pharmacies and other settings where pharmacists practice, including training, space, personnel, recruitment and enrollment, retention, and sustainability.
World Health Organization. Diabetes. https://www.who.int/westernpacific/health-topics/diabetes (accessed Dec 17, 2020).
National Diabetes Statistics Report 2020. Estimates of diabetes and its burden in the United States. https://www.cdc.gov/diabetes/data/statistics-report/index.html (accessed May 2, 2021).
American Diabetes Association. Economic Costs of Diabetes in the U.S. in 2017. Diabetes Care. 2018;41(5):917-928. https://doi.org/10.2337/dci18-0007
American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2021. Diabetes Care. 2021;44(Suppl 1):S15-S33. https://doi.org/10.2337/dc21-s002
Centers for Disease Control and Prevention. Prediabetes - Your Chance to Prevent Type 2 Diabetes. https://www.cdc.gov/diabetes/basics/prediabetes.html (accessed May 2, 2021).
Ligthart S, van Herpt TT, Leening MJ, et al. Lifetime risk of developing impaired glucose metabolism and eventual progression from prediabetes to type 2 diabetes: a prospective cohort study. Lancet Diabetes Endocrinol. 2016;4(1):44-51. https://doi.org/10.1016/s2213-8587(15)00362-9
Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393-403. https://doi.org/10.1056/nejmoa012512
Ackermann RT. From Programs to Policy and Back Again: The Push and Pull of Realizing Type 2 Diabetes Prevention on a National Scale. Diabetes Care. 2017;40(10):1298-1301. https://doi.org/10.2337/dci17-0012
Katangwe T, Family H, Sokhi J, Kirkdale CL, Twigg MJ. The community pharmacy setting for diabetes prevention: A mixed methods study in people with 'pre-diabetes'. Res Social Adm Pharm. 2020;16(8):1067-1080. https://doi.org/10.1016/j.sapharm.2019.11.001
Centers for Disease Control and Prevention. Action Guide for Community Pharmacists. CDC. https://www.cdc.gov/diabetes/prevention/pharmacist/action-guide.html (accessed Feb 24, 2021).
Gamston CE, Kirby AN, Hansen RA, et al. Description of a pharmacist-led diabetes prevention service within an employer-based wellness program. J Am Pharm Assoc (2003). 2019;59(5):736-741. https://doi.org/10.1016/j.japh.2019.05.023
Lapping AD, Carroll JC, Coley KC, et al. Implementation strategies from deployment of the National Diabetes Prevention Program in Pennsylvania community pharmacies. J Am Pharm Assoc (2003). 2020;60(3S):S29-S36.e1. https://doi.org/10.1016/j.japh.2020.01.010
Moin T, Duru OK, Turk N, et al. Effectiveness of Shared Decision-making for Diabetes Prevention: 12-Month Results from the Prediabetes Informed Decision and Education (PRIDE) Trial. J Gen Intern Med. 2019;34(11):2652-2659. https://doi.org/10.1007/s11606-019-05238-6
Yap D. Pharmacists’ expanding role in diabetes care sparked by research and innovation. Pharm Today. 2018;24(11):43. https://doi.org/10.1016/j.ptdy.2018.10.024
Lifestyle Coach Resources. https://nationaldppcsc.cdc.gov/s/topic/0TOt0000000GwhGGAS/lifestyle-coach-resources (accessed Feb 24, 2021).
Vick J. A Guide for Using Telehealth Technologies in Diabetes Self-Management Education and Support and in the National Diabetes Prevention Program Lifestyle Change Program. https://www.cdc.gov/diabetes/pdfs/programs/E_Telehealth_translation_product_508.pdf (accessed Feb 24, 2021).
Joiner KL, Nam S, Whittemore R. Lifestyle interventions based on the diabetes prevention program delivered via eHealth: A systematic review and meta-analysis. Prev Med. 2017;100:194-207. https://doi.org/10.1016/j.ypmed.2017.04.033
Michaelides A, Raby C, Wood M, Farr K, Toro-Ramos T. Weight loss efficacy of a novel mobile Diabetes Prevention Program delivery platform with human coaching. BMJ Open Diabetes Res Care. 2016;4(1):e000264. https://doi.org/10.1136/bmjdrc-2016-000264
Chiguluri V, Barthold D, Gumpina R, Sweet CC, Pieratt J, Cordier TA, Matanich R, Renda A, Prewitt TG. Virtual Diabetes Prevention Program—Effects on Medicare Advantage Health Care Costs and Utilization. Diabetes. 2018;67(Supplement 1):45LB. https://doi.org/10.2337/db18-45-LB
Moin T, Damschroder LJ, AuYoung M, et al. Results From a Trial of an Online Diabetes Prevention Program Intervention. Am J Prev Med. 2018;55(5):583-591. https://doi.org/10.1016/j.amepre.2018.06.028
Woodard LJ, McKennon S, Danielson J, Knuth J, Odegard P. An Elective Course to Train Student Pharmacists to Deliver a Community-based Group Diabetes Prevention Program. Am J Pharm Educ. 2016;80(6):106. https://doi.org/10.5688/ajpe806106
Egbujie BA, Delobelle PA, Levitt N, Puoane T, Sanders D, van Wyk B. Role of community health workers in type 2 diabetes mellitus self-management: A scoping review. PLoS One. 2018;13(6):e0198424. https://doi.org/10.1371/journal.pone.0198424
Cannon MJ, Masalovich S, Ng BP, et al. Retention Among Participants in the National Diabetes Prevention Program Lifestyle Change Program, 2012-2017. Diabetes Care. 2020;43(9):2042-2049. https://doi.org/10.2337/dc19-2366
National Diabetes Prevention Program. Reimbursement Models for Commercial Payers. https://coveragetoolkit.org/commercial-plans/commercial-plans-contracting/commercial-plans-reimbursement/ (accessed Feb 24, 2021).
Parsons AS, Raman V, Starr B, Zezza M, Rehm CD. Medicare underpayment for Diabetes Prevention Program: implications for DPP suppliers. Am J Manag Care. 2018;24(10):475-478.
Copyright (c) 2021 The Authors
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.