November is designated Diabetes Month by the American Diabetes Association. Ninety-five percent of people with diabetes have type 2 diabetes. Type 2 diabetes is strongly associated with overweight, obesity and unhealthy lifestyle habits leading to excessive weight gain in adults, and more recently in adolescents.
Diabetes is the most expensive health condition in the United States, with more than $100 billion per year in direct health care costs. (Heart disease comes in second at $88 billion per year). Health care is a top 5 contributor to our GDP, and diabetes is a significant driver of that financial engine. As our nation seeks to reduce health care costs and expenditures, we must address the explosion of people who are affected by this disease.
Thankfully, type 2 diabetes is preventable, and is proceeded by a condition known as prediabetes. It is estimated that 86 million adults (one in three) in the United States have prediabetes, yet nine out of 10 people don’t know they have it. People with prediabetes are more likely to develop type 2 diabetes. Twenty-five percent of those with prediabetes with develop type 2 diabetes in three to five years, and nearly half will develop type 2 diabetes in 10 years. Preventing this transition is dependent on changing lifestyle – in particular diet and physical activity, with a goal of achieving a 5 percent to 10 percent weight loss. For a 200-pound person, this equates to losing and sustaining a 10-20 pound weight loss. A 10 percent weight loss is associated with an 85% reduction in the risk of developing type 2 diabetes.
The Centers for Disease Control and Prevention (CDC) oversees the Diabetes Prevention Program, or DPP. The DPP is a weekly class for 16 weeks, followed by six monthly follow-up sessions. Classes are taught by lifestyle coaches who follow a standardized curriculum. Participants learn how to shop for and prepare healthy meals, increase physical activity, overcoming barriers and sustaining behavior change.
A large national study found participants in the lifestyle change program who lost 7 percent of their body weight had a 58 percent lower likelihood of developing type 2 diabetes compared to a usual care control group. Adults over age 60 years experienced a 71 percent decrease in the likelihood of type 2 diabetes. The average weight loss for all participants in the lifestyle program was eight pounds. Even more impressive, was that those in the lifestyle program reduced their likelihood of type 2 diabetes by 34 percent at 10 years since starting the program compared to the study’s control group.
Starting 2018, the Center for Medicare and Medicaid Services (CMS) will provide the DPP as an insurance benefit for Medicare enrollees. Several commercial insurance carriers also pay for the DPP, as do some large employer groups. In addition to the face-to-face classroom DPP, several virtual/online DPP programs are also available. For those without insurance coverage, the DPP costs between $450 and $750 for the year-long program. Some scholarship programs exist to support participation for those with limited financial resources.
Utahns can access programs through the CDC DPP website.
Type 2 diabetes is preventable. Prediabetes is common. To see if you are at risk for prediabetes, take the online quiz. If you score 5 or more on the quiz, schedule an appointment with your primary care provider who can order a blood test to see if you have prediabetes. Then talk to your doctor about the diabetes prevention program STAT (Screen Test Act Today).
Elizabeth Joy, MD, MPH, is medical director of community health and food & nutrition at Intermountain Healthcare. Kim Brunisholz, Ph.D., is senior scientist at Intermountain Healthcare.