Transcript Social and Policy Solutions to Prevent and Manage Diabetes Ann Albright, PhD, RD Director, Division of Diabetes Translation Centers for Disease Control and Prevention The.

Social and Policy Solutions to
Prevent and Manage Diabetes
Ann Albright, PhD, RD
Director, Division of Diabetes Translation
Centers for Disease Control and Prevention
The findings and conclusions in this presentation are those of the author and do not necessarily represent the views of the CDC.
POLICY DISTRIBUTION
POLICY AVAILABILITY
Diffusion of
interventions
POLICY EFFICIENCY
Supply
EFFECTIVENESS
Biggest effect on
most people
EFFICACY
Real world
settings
BASIC SCIENCE
Ideal
settings
Molecular/
physiological
Ecological
Model
Community and policy
System, group,
culture
Family,
friends, small
group
Individual
The health of individuals is inseparable from the health of communities
(Healthy People 2010)
Prevention of Type 2 Diabetes
The Community – Clinic Partnership Model
Community
Insurers
Partnership Zone
}
Employers
Informed Population
Strong Community
Organizations
Proactive Practice
Team
Diagnosis of
Prediabetes
Decision Support
Reimbursement
Screening for
High Risk
Structured Lifestyle
Programs
Healthy Public
Policy
Supportive
Environments
Total Population
Clinic
Information
Systems
Regular
Glucose
Monitoring
Pre-diabetes
Diabetes
Informed,
Activated
Patients
Complications
NEXT-D Study
 Public health efforts to reduce diabetes impact have included an
array of policies aimed at promoting preventive health behaviors,
improving access and quality of care, and reducing disparities
 These include diverse policy initiatives by health plans,
employers, communities, and legislative bodies at local, state,
and federal levels
 These innovations have diverse mechanisms of actions -
reimbursement (i.e. benefit) structure, pricing, food and product
labeling, employer-based approaches, and economic incentives
and disincentives.
NEXT-D Study
 Unfortunately, most system- and macro-level policy innovations
go untested or thoroughly evaluated, particularly if they emanate
from outside the clinical encounter
 The unabated increases in obesity, diabetes, and
cardiometabolic disease indicate a need to identify and prioritize
system- and policy-level “best practices”
 A new multi-center research infrastructure and platform has been
developed to assess the impact of naturally occurring innovations
in health policy, system change, and health-related legislation on
preventive care and behaviors to reduce diabetes risk in the
population
NEXT-D is Evaluating
 Impact of employer-mandated high deductible health plans




on diabetes outcomes
Health plan coverage of community-based diabetes
prevention program
Effectiveness of employer-based detection, outreach, and
incentives for prevention of diabetes and post-partum
glucose screening
Use of electronic medical records with decision support on
prediabetes and diabetes outcomes
Effectiveness of a health plan designed to reduce out-ofpocket costs
Medical
Management
SelfManagement
Ongoing
Support
Critical Elements of Diabetes Management
Policy Efforts in State DPCPs
 Reimbursement for DSME/CDSMP
 Increasing sustainability of community health
workers
 Increasing role of allied health professionals in
medical management of diabetes
Percent
developing
diabetes of Diabetes
DPP Research
Study:
Incidence
Cumulative incidence (%)
All
Placebo (n=1082)
Metformin (n=1073, p<0.001 vs. Placebo)
Lifestyle (n=1079, p<0.001 vs. Met , p<0.001 vs. Plac )
Lifestyle
vs.Plac)
Metformin ,
Metformin(n=1079,
(n=1073, p<0.001
p<0.001 vs.
Placebo (n=1082) p<0.001 vs. Placebo)
40
30
participants
Risk reduction
31% by metformin
58% by lifestyle
20
10
0
0
1
2
3
4
Years from randomization
The DPP Research Group, NEJM 346:393-403, 2002
Summary of Benefits of DPP Lifestyle Program
 Treating 100 high risk adults (age 50) for 3
years…
• Prevents 15 new cases of type 2 diabetes1
• Prevents 162 missed work days2
• Avoids the need for BP/Chol pills in 11 people3
• Adds the equivalent of 20 perfect years of
•
1
health4
Avoids $91,400 in healthcare costs5
DPP Research Group. N Engl J Med. 2002 Feb 7;346(6):393-403
DPP Research Group. Diabetes Care. 2003 Sep;26(9):2693-4
3 Ratner, et al. 2005 Diabetes Care 28 (4), pp. 888-894
4 Herman, et al. 2005 Ann Intern Med 142 (5), pp. 323-32
5 Ackermann, et al. 2008 Am J Prev Med 35 (4), pp. 357-363; estimates scaled to 2008 $US
2
Cost of DPP 1-1 Format
 First 12 months cost = $1,400 per participant
 Total 3 year cost = $2,780 per participant
 With inflation, three year costs of this program in
2010 exceed $3,500 per participant
Cost of Group-Based Format
 $275 -$325 per participant when using trained
Y staff (Ackermann, et al)
 $550 per participant when using CDEs
(Amundsen, et al)
 About $500 per person when implementing to
scale since it includes engaging participants,
enrollment, managing eligibility, etc.
National Diabetes Prevention Program
Goal:
 Systematically scale the translated model of the
Diabetes Prevention Program (DPP) for high risk
persons in collaboration with community-based
organizations that have necessary infrastructure,
health payers, health care professionals, public
health, academia, and others to reduce the
incidence of type 2 diabetes in the United States.
NATIONAL DIABETES PREVENTION PROGRAM
Components
Training: Increase
Workforce
Recognition
Program: Quality
Train the workforce
that can implement
the program cost
effectively
Implement a
recognition program
that will:
• Assure quality
• Lead to
reimbursement
• Allow CDC to
develop a program
registry
Intervention
Sites: Deliver
Program
Health Marketing:
Support Program
Uptake
Develop
intervention sites
that will build
infrastructure and
provide the
program
Increase referrals
to and use of the
prevention program
Resources and Media Contacts
 Division of Diabetes Translation
• www.cdc.gov/diabetes
 National Diabetes Education Program
• www.yourdiabetesinfo.org
 Media Contacts
•
•
Email: [email protected]
Phone: 404-639-3286