Bright Spot: National Diabetes Prevention Program
Photo by Caroline Attwood on Unsplash
This bright spot was originally published in the 100 Million Healthier Lives Change Library and is brought to you through partnership with 100 Million Healthier Lives and the Institute for Healthcare Improvement.
Overview
Detailed Description
The CDC-led National Diabetes Prevention Program is an evidence-based lifestyle change program for preventing type 2 diabetes. Participants work with a lifestyle coach in a group setting to receive a 1-year lifestyle change program that includes 16 core sessions (usually 1 per week) and 6 post-core sessions (1 per month). This program teaches participants strategies for incorporating physical activity into daily life and eating healthy. Lifestyle coaches work with participants to identify emotions and situations that can sabotage their success, and the group process encourages participants to share strategies for dealing with challenging situations. The Centers for Disease Control and Prevention (CDC) Diabetes Prevention Recognition Program (DPRP) is a key component of the National Diabetes Prevention Program. The purpose of the DPRP is to recognize organizations that have shown that they can effectively deliver a lifestyle change intervention program (lifestyle intervention) to prevent type 2 diabetes. Organizations interested in offering lifestyle classes can apply for recognition through DPRP. CDC will provide recognized programs listed in the DPRP registry with supportive tools, including performance analysis, training, and technical assistance. This assistance should improve the classes and help with the required reporting of program evaluation data.
Expected Outcomes
This program can help participants cut their risk of developing type 2 diabetes in half. The Diabetes Prevention Program research study showed that making modest behavior changes helped participants lose 5% to 7% of their body weight - that is 10 to 14 pounds for a 200-pound person.These lifestyle changes reduced the risk of developing type 2 diabetes by 58% in people with pre-diabetes. Participants aim to lose 5 to 7 percent of their body weight by reducing fat and calories, and by being physically active for 150 minutes a week.
Key Principles
The key features of the lifestyle program are: very clear weight loss and physical activity goals, run by individual/family case managers or lifestyle coaches, ongoing and intensive, and includes a maintenance period, participants can tailor the program to their needs can meet the needs of an ethnically diverse population through its materials and strategies; and an extensive local and national network of training, feedback, and clinical support for lifestyle coaches.
Key Steps for Implementation
A community organization considering whether to offer the lifestyle change program can prepare by: Reviewing the National Diabetes Prevention Program curriculum on the CDC Web site. Using the capacity assessment test in the DPRP Standards to assess its current ability to offer the National Diabetes Prevention Program lifestyle change program. Identifying potential lifestyle coaches affiliated with the organization and contacting DTTAC for assistance in training a coach using DTTAC master trainers.
The lifestyle program consists of the following: A 16-session "core" lifestyle change class (lifestyle class) for participants. The class is taught by a trained "lifestyle coach." It follows an approved curriculum that has been shown to work and contains all of the elements included in the original Diabetes Prevention Program (DPP) Lifestyle Curriculum. At least six "post-core" follow-up sessions. For evaluation of performance, programs recognized by the DPRP submit reports to the DPRP every 6 months with data on participants' progress in their classes. An organization receives "pending recognition" status when it has agreed to use an evidence-based curriculum, that meets duration, intensity, and reporting requirements described in the DPRP Standards and agrees to provide data reports to DPRP every 6 months.
Programs remain in "pending recognition" status for 24 months at which time "full recognition" is awarded to programs that meet the performance requirements described in the DPRP Standards. "Full recognition" means that a program has demonstrated effectiveness by achieving all of the requirements described in the DPRP Standards.
Other Key Requirements
Pending and full recognition will be offered through DPRP. After an organization has applied for recognition with DPRP, the organization will achieve pending recognition if it agrees to the curriculum, duration, and intensity requirements. Each organization will be required to submit evaluation data to DPRP every six months from the date of the first lifestyle intervention core group session offered after the application acceptance date (henceforth referred to as the first session). This will allow for timely data analysis and provide opportunities for the organization to receive interim feedback on its progress in meeting recognition requirements. Recognition status will be assessed 24 months after the first session.
The organization will receive full recognition status if it has demonstrated program effectiveness by achieving all of the remaining seven requirements.These recognition requirements will be assessed based on data from all of the lifestyle interventions (each having a duration of 1 year) that were delivered in their entirety by the organization during the 24-month period. If after 24 months the organization has not achieved all of the requirements for full recognition, it will continue in pending recognition status for an additional 12 months. During this period, DPRP will provide technical assistance to the organization to help it achieve full recognition.
A 36-month evaluation will be performed based on data from all of the lifestyle interventions completed during those additional 12 months. If the organization is not successful in achieving full recognition at the end of this period (36 months after the first session), it will lose recognition and must wait 12 months before reapplying for recognition. Fully recognized organizations will continue to submit evaluation data every six months and will be re-evaluated every 24 months (based on data from all of the lifestyle interventions completed during the most recent 24-month period), but will not need to reapply for recognition.
Policies, Laws and Regulations
If physical activity is offered, it is the organization's responsibility to have procedures in place to assure safety. This may include obtaining a liability waiver from the participant. It is also the organization's responsibility to comply with any federal, state, and/or local laws governing Individual/family-level identifiable data, including those laws related to data collection, storage, use and disclosure.
Required Staffing (FTEs)
Recognized programs must use a lifestyle coach to deliver the program to participants. He/she will provide support and guidance to participants in the lifestyle program and implement standard curriculum designed for the lifestyle program. Recognized programs should also designate an individual/family to serve in the role of diabetes prevention coordinator. If a recognized program serves a large number of participants at any one time, multiple coordinators may be required. Similarly, if a recognized program serves a small number of participants at any one time, it may be possible for a lifestyle coach to serve simultaneously in the role of the diabetes coordinator. The coordinator will implement the lifestyle program, supervise daily operations related to the lifestyle program, provide support and guidance to lifestyle coaches, and ensure that the program achieves quality performance outcomes.
Special Funding
In North Carolina, the state is funded to build capacity to deliver DPP in 5 regions of the state: Health Director Regions 1, 7, 8, 9, 10.
Special Infrastructure
Any venue agreeable to the organization and suitable for the activities to be undertaken can be used for group lifestyle programs. However, lifestyle programs often provide private settings in which participants can be weighed or meet individual/family with lifestyle coaches.
Ensure physical safety of participants if physical activity is offered by the organization. Ensure data privacy. Supplies (scale to weigh people, journals for participants to track their eating habits, participant training manuals, handouts related to sessions). Participant incentives.
Training
The Diabetes Training and Technical Assistance Center (DTTAC) at Emory University trains the lifestyle coaches to deliver the National Diabetes Prevention Program lifestyle change program.The center delivers a 2-day in-person training at various locations across the country. On-site trainings are also offered by the center. Training fees are $670 - $750 per person depending on the location.
Types of Staff
Lifestyle coaches may have credentials (e.g., RD, RN), but credentials are not required. Individual/families must have been trained as lifestyle coaches to be considered as diabetes prevention coordinators.
Return on Investment Details
Local health care providers can be involved to refer patients to the program. The CDC provides funding to the following organizations to expand the National DPP network of organizations offering the program: The American Association of Diabetes Educators, America's Health Insurance Plans, Black Women's Health Imperative, National Association of Chronic Disease Directors, Optum Health care Solutions, YMCA of the USA.
Funded organizations can provide information to employers about offering the lifestyle change program as a covered health benefit for employees. They can also work with third-party payers, including public and private health insurance companies, to facilitate performance-based reimbursement directly to organizations delivering the lifestyle change program.
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