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Current Diabetes Reports

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Open Access 01-09-2019 | Obesity | Diabetes Epidemiology (E Selvin and K Foti, Section Editors)

Public Health Approaches to Type 2 Diabetes Prevention: the US National Diabetes Prevention Program and Beyond

Authors: Stephanie M. Gruss, Kunthea Nhim, Edward Gregg, Miriam Bell, Elizabeth Luman, Ann Albright

Published in: Current Diabetes Reports | Issue 9/2019

Abstract

Purpose of Review

This article highlights foundational evidence, translation studies, and current research behind type 2 diabetes prevention efforts worldwide, with focus on high-risk populations, and whole-population approaches as catalysts to global prevention.

Recent Findings

Continued focus on the goals of foundational lifestyle change program trials and their global translations, and the targeting of those at highest risk through both in-person and virtual modes of program delivery, is critical. Whole-population approaches (e.g., socioeconomic policies, healthy food promotion, environmental/systems changes) and awareness raising are essential complements to efforts aimed at high-risk populations.

Summary

Successful type 2 diabetes prevention strategies are being realized in the USA through the National Diabetes Prevention Program and elsewhere in the world. A multi-tiered approach involving appropriate risk targeting and whole-population efforts is essential to curb the global diabetes epidemic.

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• International Diabetes Federation. Diabetes atlas 8^th edition 2017 global fact sheet. 2017. Available at https://www.idf.org/aboutdiabetes/what-is-diabetes/facts-figures.html. Accessed April 14, 2019. Findings indicate the significant and costly economic and disease burden that diabetes has across the world.

Centers for Disease Control and Prevention. Diabetes 2017 report card. 2017. Available at https://www.cdc.gov/diabetes/pdfs/library/diabetesreportcard2017-508.pdf. Accessed April 14, 2019.

• American Diabetes Association. Economic costs of diabetes in the U.S. in 2017. Diabetes Care. 2018;41(5):917–28. https://doi.org/10.2337/dci18-0007 Findings indicate the significant and costly economic and productivity burden that diabetes has in the USA. CrossRefPubMedCentral

Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344(18):1343–50. https://doi.org/10.1056/nejm200105033441801. CrossRefPubMed

Noble D, Mathur R, Dent T, Meads C, Greenhalgh T. Risk models and scores for type 2 diabetes: systematic review. Br Med J (Clin Res Ed). 2011;343:d7163.CrossRef

Modesti PA, Galanti G, Cala P, Calabrese M. Lifestyle interventions in preventing new type 2 diabetes in Asian populations. Intern Emerg Med. 2016;11(3):375–84. https://doi.org/10.1007/s11739-015-1325-2.CrossRefPubMed

Pearson-Stuttard J, Bandosz P, Rehm CD, Penalvo J, Whitsel L, Gaziano T, et al. Reducing US cardiovascular disease burden and disparities through national and targeted dietary policies: a modelling study. PLoS Med. 2017;14(6):e1002311. https://doi.org/10.1371/journal.pmed.1002311.CrossRefPubMedPubMedCentral

Konchak JN, Moran MR, O'Brien MJ, Kandula NR, Ackermann RT. The state of diabetes prevention policy in the USA following the Affordable Care Act. Curr Diab Rep. 2016;16(6):55. https://doi.org/10.1007/s11892-016-0742-6. CrossRefPubMed

Pan XR, Li GW, Hu YH, Wang JX, Yang WY, An ZX, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care. 1997;20(4):537–44.CrossRef

10.

Li G, Zhang P, Wang J, Gregg EW, Yang W, Gong Q, et al. The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study. Lancet. 2008;371(9626):1783–9. https://doi.org/10.1016/s0140-6736(08)60766-7.CrossRef

11.

Gong Q, Gregg EW, Wang J, An Y, Zhang P, Yang W, et al. Long-term effects of a randomised trial of a 6-year lifestyle intervention in impaired glucose tolerance on diabetes-related microvascular complications: the China Da Qing Diabetes Prevention Outcome Study. Diabetologia. 2011;54(2):300–7. https://doi.org/10.1007/s00125-010-1948-9.CrossRefPubMed

12.

Gong Q, Zhang P, Wang J, Ma J, An Y, Chen Y, et al. Morbidity and mortality after lifestyle intervention for people with impaired glucose tolerance: 30-year results of the Da Qing Diabetes Prevention Outcome Study. Lancet Diabetes Endocrinol. 2019. https://doi.org/10.1016/S2213-8587(19)30093-2.CrossRef

13.

•• Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, 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 Findings from this study demonstrate that diabetes incidence reduction in those at high risk for type 2 diabetes is possible with both lifestyle interventions and metformin use, but greater through lifestyle intervention overall. CrossRef

14.

Knowler WC, Fowler SE, Hamman RF, Christophi CA, Hoffman HJ, Brenneman AT, et al. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet. 2009;374(9702):1677–86. https://doi.org/10.1016/s0140-6736(09)61457-4.CrossRefPubMed

15.

Diabetes Prevention Program Research Group. Long-term effects of lifestyle intervention or metformin on diabetes development and microvascular complications over 15-year follow-up: the Diabetes Prevention Program Outcomes Study. Lancet Diabetes Endocrinol. 2015;3(11):866–75. https://doi.org/10.1016/s2213-8587(15)00291-0.CrossRefPubMedCentral

16.

Diabetes Prevention Program Research Group. The 10-year cost-effectiveness of lifestyle intervention or metformin for diabetes prevention: an intent-to-treat analysis of the DPP/DPPOS. Diabetes Care. 2012;35(4):723–30. https://doi.org/10.2337/dc11-1468.CrossRef

17.

The Diabetes Prevention Program Research Group. The Diabetes Prevention Program: design and methods for a clinical trial in the prevention of type 2 diabetes. Diabetes Care. 1999;22(4):623–34.CrossRef

18.

Lindstrom J, Ilanne-Parikka P, Peltonen M, Aunola S, Eriksson JG, Hemio K, et al. Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study. Lancet. 2006;368(9548):1673–9. https://doi.org/10.1016/s0140-6736(06)69701-8.CrossRef

19.

Makrilakis K, Liatis S, Grammatikou S, Perrea D, Katsilambros N. Implementation and effectiveness of the first community lifestyle intervention programme to prevent type 2 diabetes in Greece. The DE-PLAN study. Diabet Med. 2010;27(4):459–65. https://doi.org/10.1111/j.1464-5491.2010.02918.x.CrossRefPubMed

20.

Kosaka K, Noda M, Kuzuya T. Prevention of type 2 diabetes by lifestyle intervention: a Japanese trial in IGT males. Diabetes Res Clin Pract. 2005;67(2):152–62. https://doi.org/10.1016/j.diabres.2004.06.010.CrossRefPubMed

21.

Ramachandran A, Snehalatha C, Mary S, Mukesh B, Bhaskar AD, Vijay V. The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1). Diabetologia. 2006;49(2):289–97. https://doi.org/10.1007/s00125-005-0097-z.CrossRef

22.

Ramachandran A, Snehalatha C, Yamuna A, Mary S, Ping Z. Cost-effectiveness of the interventions in the primary prevention of diabetes among Asian Indians: within-trial results of the Indian Diabetes Prevention Programme (IDPP). Diabetes Care. 2007;30(10):2548–52. https://doi.org/10.2337/dc07-0150.CrossRefPubMed

23.

Davidson A. Translational research: what does it mean? Anesthesiology. 2011;115(5):909–11. https://doi.org/10.1097/ALN.0b013e3182337a5e.CrossRefPubMed

24.

Ali MK, Echouffo-Tcheugui J, Williamson DF. How effective were lifestyle interventions in real-world settings that were modeled on the Diabetes Prevention Program? Health Aff (Millwood). 2012;31(1):67–75. https://doi.org/10.1377/hlthaff.2011.1009.CrossRef

25.

•• Gilis-Januszewska A, Piwonska-Solska B, Lindstrom J, Wojtowicz E, Tuomilehto J, Schwarz PEH, et al. Determinants of weight outcomes in type 2 diabetes prevention intervention in primary health care setting (the DE-PLAN project). BMC Public Health. 2018;18(1):97. https://doi.org/10.1186/s12889-017-4977-1 Findings from this study indicate that persons with a higher body mass index, increased glucose, and lower education (i.e., at higher risk for type 2 diabetes) achieved successful weight loss of 5% or more after a yearlong lifestyle change intervention as compared to those with lower risk for type 2 diabetes. CrossRefPubMedPubMedCentral

26.

Thomas C, Sadler S, Breeze P, Squires H, Gillett M, Brennan A. Assessing the potential return on investment of the proposed UK NHS diabetes prevention programme in different population subgroups: an economic evaluation. Br Med J Open. 2017;7(8):e014953. https://doi.org/10.1136/bmjopen-2016-014953.CrossRef

27.

Laatikainen T, Dunbar JA, Chapman A, Kilkkinen A, Vartiainen E, Heistaro S, et al. Prevention of type 2 diabetes by lifestyle intervention in an Australian primary health care setting: Greater Green Triangle (GGT) Diabetes Prevention Project. BMC Public Health. 2007;7:249. https://doi.org/10.1186/1471-2458-7-249.CrossRefPubMedPubMedCentral

28.

Janus ED, Best JD, Davis-Lameloise N, Philpot B, Hernan A, Bennett CM, et al. Scaling-up from an implementation trial to state-wide coverage: results from the preliminary Melbourne Diabetes Prevention Study. Trials. 2012;13:152. https://doi.org/10.1186/1745-6215-13-152.CrossRefPubMedPubMedCentral

29.

Tate DF, Jackvony EH, Wing RR. Effects of internet behavioral counseling on weight loss in adults at risk for type 2 diabetes: a randomized trial. JAMA. 2003;289(14):1833–6. https://doi.org/10.1001/jama.289.14.1833.CrossRefPubMed

30.

Ramachandran A, Snehalatha C, Ram J, Selvam S, Simon M, Nanditha A, et al. Effectiveness of mobile phone messaging in prevention of type 2 diabetes by lifestyle modification in men in India: a prospective, parallel-group, randomised controlled trial. Lancet Diabetes Endocrinol. 2013;1(3):191–8. https://doi.org/10.1016/s2213-8587(13)70067-6.CrossRefPubMed

31.

Nanditha A, Snehalatha C, Raghavan A, Vinitha R, Satheesh K, Susairaj P, et al. The post-trial analysis of the Indian SMS diabetes prevention study shows persistent beneficial effects of lifestyle intervention. Diabetes Res Clin Pract. 2018;142:213–21. https://doi.org/10.1016/j.diabres.2018.05.042.CrossRefPubMed

32.

Centers for Medicare & Medicaid Services. 2016 annual report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds. Available at https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/downloads/tr2016.pdf. Accessed April 14, 2019.

33.

Herman WH. The economics of diabetes prevention. Med Clin North Am. 2011;95(2):373–84, viii. https://doi.org/10.1016/j.mcna.2010.11.010.CrossRefPubMedPubMedCentral

34.

US Congress. H.R.4124 - Diabetes Prevention Act of 2009. Available at https://www.congress.gov/bill/111th-congress/house-bill/4124. Accessed April 14, 2019.

35.

Albright AL, Gregg EW. Preventing type 2 diabetes in communities across the U.S.: the National Diabetes Prevention Program. Am J Prev Med. 2013;44(4 Suppl 4):S346–51. https://doi.org/10.1016/j.amepre.2012.12.009.CrossRefPubMedPubMedCentral

36.

Centers for Disease Control and Prevention. Diabetes Prevention Recognition Program data dashboard. Accessed April 11, 2019.

37.

Centers for Disease Control and Prevention. 2018 Diabetes Prevention Recognition Program standards and operating procedures. Available at https://www.cdc.gov/diabetes/prevention/pdf/dprp-standards.pdf. Accessed April 14, 2019.

38.

Centers for Disease Control and Prevention. Insurance coverage for the US National Diabetes Prevention Program State reported data. Accessed May 14, 2019.

39.

Centers for Medicare & Medicaid Services. Medicare Diabetes Prevention Program (MDPP) expanded model. Available at https://innovation.cms.gov/initiatives/medicare-diabetes-prevention-program/. Accessed April 14, 2019.

40.

Ely EK, Gruss SM, Luman ET, Gregg EW, Ali MK, Nhim K, et al. A national effort to prevent type 2 diabetes: participant-level evaluation of CDC’s National Diabetes Prevention Program. Diabetes Care. 2017;40(10):1331–41. https://doi.org/10.2337/dc16-2099.CrossRefPubMedPubMedCentral

41.

• Ali MK, McKeever Bullard K, Imperatore G, Benoit SR, Rolka DB, Albright AL, et al. Reach and use of diabetes prevention services in the United States, 2016-2017. JAMA Netw Open. 2019;2(5):e193160. https://doi.org/10.1001/jamanetworkopen.2019.3160 Findings from this study offer the basis by which to assess future diabetes prevention lifestyle change programs and coverage for such programs, strategies for identification of prediabetes, and referral practices into such programs that lead to retention. CrossRefPubMedPubMedCentral

42.

Nhim K, Khan T, Gruss SM, Wozniak G, Kirley K, Schumacher P, et al. Primary care providers’ prediabetes screening, testing, and referral behaviors. Am J Prev Med. 2018;55(2):e39–47. https://doi.org/10.1016/j.amepre.2018.04.017.CrossRefPubMedPubMedCentral

43.

Centers for Disease Control and Prevention. Diabetes prevention impact toolkit. Available at https://nccd.cdc.gov/toolkit/diabetesimpact. Accessed April 14, 2019.

44.

Hafez D, Fedewa A, Moran M, O'Brien M, Ackermann R, Kullgren JT. Workplace interventions to prevent type 2 diabetes mellitus: a narrative review. Curr Diab Rep. 2017;17(2):9. https://doi.org/10.1007/s11892-017-0840-0. CrossRefPubMedPubMedCentral

45.

Ad Council. Do I have prediabetes Available at DoIHavePrediabetes.org. Accessed April 14, 2019.

46.

Centers for Disease Control and Prevention. Prediabetes campaign results report, April 2019 Accessed April 4, 2019.

47.

Andreyeva T, Long MW, Brownell KD. The impact of food prices on consumption: a systematic review of research on the price elasticity of demand for food. Am J Public Health. 2010;100(2):216–22. https://doi.org/10.2105/ajph.2008.151415.CrossRefPubMedPubMedCentral

48.

Calancie L, Leeman J, Jilcott Pitts SB, Khan LK, Fleischhacker S, Evenson KR, et al. Nutrition-related policy and environmental strategies to prevent obesity in rural communities: a systematic review of the literature, 2002-2013. Prev Chronic Dis. 2015;12:E57. https://doi.org/10.5888/pcd12.140540.CrossRefPubMedPubMedCentral

49.

Olstad DL, Teychenne M, Minaker LM, Taber DR, Raine KD, Nykiforuk CI, et al. Can policy ameliorate socioeconomic inequities in obesity and obesity-related behaviours? A systematic review of the impact of universal policies on adults and children. Obes Rev. 2016;17(12):1198–217. https://doi.org/10.1111/obr.12457.CrossRefPubMed

50.

Lichtenstein AH, Carson JS, Johnson RK, Kris-Etherton PM, Pappas A, Rupp L, et al. Food-intake patterns assessed by using front-of-pack labeling program criteria associated with better diet quality and lower cardiometabolic risk. Am J Clin Nutr. 2014;99(3):454–62. https://doi.org/10.3945/ajcn.113.071407.CrossRefPubMed

51.

•• Hyseni L, Atkinson M, Bromley H, Orton L, Lloyd-Williams F, McGill R, et al. The effects of policy actions to improve population dietary patterns and prevent diet-related non-communicable diseases: scoping review. Eur J Clin Nutr. 2017;71(6):694–711. https://doi.org/10.1038/ejcn.2016.234 Findings are from a large, worldwide systematic and non-systematic review that highlights successful whole-population strategies for preventing and reducing non-communicable diseases. CrossRefPubMed

52.

Niebylski ML, Redburn KA, Duhaney T, Campbell NR. Healthy food subsidies and unhealthy food taxation: a systematic review of the evidence. Nutrition. 2015;31(6):787–95. https://doi.org/10.1016/j.nut.2014.12.010.CrossRefPubMed

53.

Colchero MA, Popkin BM, Rivera JA, Ng SW. Beverage purchases from stores in Mexico under the excise tax on sugar sweetened beverages: observational study. Br Med J (Clin Res Ed). 2016;352:h6704.

54.

Albright A, Devlin H, and Zhang X: Integrating Nutrition Therapy into Community-Based Diabetes Prevention Programs (pp 579). In: Franz MJ, Evert AB, editors. American Diabetes Association Guide to Nutrition Therapy for Diabetes, 3rd Edition; 2012.

55.

Mayne SL, Auchincloss AH, Michael YL. Impact of policy and built environment changes on obesity-related outcomes: a systematic review of naturally occurring experiments. Obes Rev. 2015;16(5):362–75. https://doi.org/10.1111/obr.12269.CrossRefPubMedPubMedCentral

Title: Public Health Approaches to Type 2 Diabetes Prevention: the US National Diabetes Prevention Program and Beyond
Authors: Stephanie M. Gruss
Kunthea Nhim
Edward Gregg
Miriam Bell
Elizabeth Luman
Ann Albright
Publication date: 01-09-2019
Publisher: Springer US
Keywords: Obesity
Obesity
Diabetes Prevention
Type 2 Diabetes
Published in: Current Diabetes Reports / Issue 9/2019
Print ISSN: 1534-4827
Electronic ISSN: 1539-0829
DOI: https://doi.org/10.1007/s11892-019-1200-z

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Abstract

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