About 1 in 3 adults in the United States have prediabetes, a condition where blood glucose levels are higher than normal, but not high enough to be diagnosed as diabetes. 

Affecting 98 million adults, prediabetes can increase the risk of heart disease, stroke and type 2 diabetes.

While it can be reversed, 8 in 10 adults are unaware that they even have prediabetes. 

To counter this growing problem, the National Diabetes Prevention Program was created by the Centers for Disease Control and Prevention in 2010 to offer an effective way to help prevent type 2 diabetes.

This national effort brought together private insurers, health care organizations, employers, community organizations, and government agencies. 

Although cost-effectiveness evaluations of the program have been conducted previously, those studies focused on clinical trials and therefore provided limited information about diabetes prevention in real-world settings. 

In a paper, published in Diabetes Care, researchers at the University of Michigan evaluated the uptake and outcomes of the National DPP using surveys from 5,948 university employees, dependents and retirees with prediabetes over two years. 

Beginning in 2015, the University of Michigan offered the National DPP at no out-of-pocket cost to university employees, dependents,and retirees who were 18 years or older with prediabetes and belonged to the university’s health insurance program. 

“We realized that there was finally an opportunity to evaluate the real-world economic impact of the National DPP,” said Shihchen Kuo, associate research scientist at the Caswell Diabetes Institute. 

“Our results can inform policy decisions about the program’s scalability and sustainability.”

National DPP helps enrollees make key lifestyle changes

The year-long program focuses on teaching participants to make lasting changes: eating healthier, adding physical activity into their daily routines, and improving coping skills. 

To do so, the participating organizations follow a CDC-approved curriculum, facilitate sessions with trained Lifestyle Coaches, and submit data on the efficacy of the program to the CDC.

“In the first six months, participants meet weekly to learn skills that help them improve their overall health. After that, they meet monthly to build on the skills they learned to maintain their positive changes,” Kuo said. 

“An important component of the program is that it can be delivered in person, through online learning, or as a combination of the two.”

Enrollees saved over $5,000 in direct medical costs

Among the participants, 575 enrolled in the National DPP. 

Over two years, they saved ~$5,000 in medical costs primarily due to lower costs of hospitalizations, outpatient visits, and emergency room visits. 

The researchers also evaluated participants’ quality-of-life using a system called the EuroQol 5-Dimension 5-Level questionnaire, which assesses mobility, self-care, usual activities, discomfort and anxiety across five levels of how problematic each dimension is to the individual. 

“We found that although the quality-of-life was unchanged, those in the National DPP had a lower probability of developing diabetes,” Kuo said. 

The researchers are expanding the study to include a longer follow-up period. 

The current work included data from the one-year intervention and one-year observational follow-up period, which is a relatively short time frame. 

Many of the previous studies adopted a three-year time frame, which allowed them to detect longer-term changes in costs and quality-of-life. 

“We also need to include more people in our study. Unfortunately, only 9.6% of the eligible population participated in the National DPP and, therefore, we couldn’t draw any conclusions on which mode of delivery worked the best, whether different patient populations showed similar results, and if the reduced medical costs were due to lower rates of hospitalization or shorter hospital stays,” Kuo said. 

Additional authors: Wen Ye, Di Wang, Laura McEwen, Claudia Villatoro Santos, and William H. Herman. 

Funding/disclosures: National Institute of Diabetes and Digestive and Kidney Diseases under R01DK109995 and P30DK092926 and the Centers for Disease Control and Prevention through grant U18DP006712.

Paper cited: “Cost-Effectiveness of the National Diabetes Prevention Program: A Real-World, 2-Year Prospective Study,” Diabetes Care.  DOI: 10.2337/dc24-1110.

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