Prevention: A Blueprint for Action. Diabetes Activities


The Diabetes Prevention Program demonstrated that prevention of type 2 diabetes is possible in high-risk adults, including adults from minority populations who are at disproportionately increased risk [55] .

The Diabetes Prevention Program clinical trial compared three approaches in overweight people with impaired glucose tolerance (IGT) to test whether type 2 diabetes could be delayed or prevented:

  • lifestyle modification [56]
  • treatment with the insulin-sensitizing drug metformin
  • standard medical advice

The Diabetes Prevention Program demonstrated that diet and exercise that achieved a 5-7 percent weight loss reduced diabetes incidence by 58 percent in participants randomized to the study's lifestyle intervention group.  Participants in this group exercised at moderate intensity.  The lifestyle intervention was effective in both men and women and in all of the racial/ethnic groups.  Lifestyle intervention worked particularly well in people over age 60, reducing the development of diabetes by 71 percent in this group.  Volunteers randomly assigned to treatment with metformin had a 31 percent lower incidence of type 2 diabetes over the 2.9 year average duration of participation in the trial.  Metformin was most effective in younger and heavier study participants.  About twice as many people in the lifestyle group compared to placebo regained normal glucose tolerance, showing that diet and exercise can reverse IGT.

Following the dramatic and positive results of the Diabetes Prevention Program, in 2002 the American Diabetes Association and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) published a position paper on “The Prevention or Delay of Type 2 Diabetes” [57] .  In addition, a subsequent National Institutes of Health (NIH) and CDC co-sponsored study showed that the lifestyle and metformin interventions were cost-effective and could be implemented in routine clinical practice [58] .  Ongoing follow-up studies of the Diabetes Prevention Program patient population are currently examining the durability of the interventions in preventing or delaying diabetes onset as well as their effects on cardiovascular disease and other diabetes complications. 

National Diabetes Education Program.
The successful and well-recognized National Diabetes Education Program, a partnership of the NIDDK, the CDC, and more than 200 public and private organizations, was established to disseminate information about the importance of glucose control in those individuals with diabetes following a successful NIDDK-supported trial.  Following announcement of the Diabetes Prevention Program results, this well-established program was expanded to launch the primary prevention campaign, Small Steps, Big Rewards, Prevent Type 2 Diabetes, in November 2002.  The Small Steps educational material contains a “Game Plan” for health care providers and patients that gives information about implementing a program to prevent or delay disease onset.  The Game Plan also includes a “fat and calorie counter” as well as a “food and activity tracker” so individuals can more easily monitor food intake and physical activity level.  The Small Steps, Big Rewards, Prevent Type 2 Diabetes campaign has reached millions of people.

Diabetes Prevention Prototype Collaborative.
A pilot with five HRSA-funded health centers was initiated in November 2002 to translate the results of the Diabetes Prevention Program into practice, utilizing the Health Disparity Collaborative strategy and models.  The Health Resources and Services Administration (HRSA), CDC, NIDDK/NIH, and the MedStar Research Institute support the Diabetes Prevention Prototype Collaborative.   Health Disparity Collaboratives represent a multi-pronged approach to improve quality that includes a care model, a system improvement model, and a model of learning and sharing that allows for systematic spread of quality improvements.  Health Centers participate in year-long intense learning and quality improvement activities that involve attending learning sessions and a final meeting to disseminate outcomes.  Health Centers report the results of nationally shared measures while disseminating successful changes throughout their system of care through uniform, nationally recognized process and outcome measures.

As part of the Diabetes Prevention Collaborative pilot, teams have tested and implemented successful strategies to identify persons at-risk for diabetes, and screen them.  As of November 2003, 3,167 high-risk persons have been identified; 903 (28.5 percent) have been screened, resulting in 276 (30.6 percent) prediabetes patients in the registry and 155 (17.2 percent) newly diagnosed persons with diabetes.  Thirty-four patients (16.6 percent) have met the goal of 7 percent or greater average weight loss.

Efforts in American Indian Populations.
American Indians and Alaska Natives (AI/AN) have the highest prevalence rate of diabetes in the U.S.  Diabetes mortality in AI/AN is increasing, as are the rates of diabetes in children and youth.  In 1979, Congress established the Indian Health Service (IHS) National Diabetes Program to address the epidemic of diabetes in American Indians/Alaska Natives (AI/AN).  The mission of the National Diabetes Program is to develop, document, and sustain a public health effort to prevent and control diabetes in AI/AN people.  The agency promotes collaborative strategies for the prevention of diabetes and its complications in the 12 IHS Administrative Service Areas (regions) through coordination of a network of 19 Model Diabetes Programs and 12 Area Diabetes Consultants.

The Special Diabetes Program for Indians grant program, first established in1997 and now extended through 2008, distributes over 96 percent of its funds through grants awarded to 318 programs under 286 administrative organizations within the 12 IHS Areas in 35 states.  Nationally, 67 percent of the new grant programs are focused on primary and secondary diabetes prevention.

Medicare Disease Management Initiatives
Section 721 of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 establishes the Chronic Care Improvement Program, a population-based approach to helping people with chronic diseases, such as diabetes, manage their illness.  CMS also has several disease management demonstrations to help people with diabetes and other chronic conditions better manage their disease and prevent complications.  A demonstration established by the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 provides disease management services and a comprehensive prescription drug benefit to 30,000 beneficiaries living in California, Arizona, and parts of Louisiana and Texas.  The Coordinated Care Demonstration established by the Balanced Budget Act of 1997, currently operating in 15 sites, is testing whether case management and disease management approaches are clinically effective and cost-effective.

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