Executive Summary: Prevent Diabetes

David went to his physician in the Minneapolis area for a check-up and found out he was at risk for getting Type 2 diabetes. His physician found his blood sugar in the prediabetic range, and explained how that condition could affect his life. David was alarmed because he had seen his mother-in-law and friends struggling to deal with diabetes. He enrolled with a local diabetes prevention program at the Y which helped him realize how poorly he was eating and showed him how to lose weight—drastically decreasing his chance of getting diabetes. The physician got David’s commitment to the program, which was covered by his health plan, and he learned healthy diet and exercise tips that he incorporated into his daily life. After a year, David has lost a significant amount of weight and greatly reduced his risk of developing diabetes.

David’s story is how our health care system should operate. But, currently there are too many obstacles to adequate diabetes screenings and getting patients into effective prevention programs. The health care system treats 29 million Americans with diabetes every year but does very little to prevent it. On top of that, roughly 33% of adults in the U.S. have prediabetes—blood glucose levels that are above the normal levels but aren’t high enough to indicate diabetes—and the vast majority of those individuals are unaware of their condition. By changing the way we diagnose and treat diabetes, patients will live a longer, healthier life and the federal government could save as much as $8.1 billion over 10 years.

This brief is one of a series of Third Way proposals that cuts waste in health care by removing obstacles to quality patient care. This approach directly improves the patient experience—when patients stay healthy, or get better quicker, they need less care. Our proposals come from innovative ideas pioneered by health care professionals and organizations, and show how to scale successful pilots from red and blue states. Together, they make cutting waste a policy agenda instead of a mere slogan.

What is Stopping Patients from Getting Quality Care?

The nation is failing to prevent diabetes for two main reasons: inadequate screenings and a need for more effective prevention programs.

Providers often do not screen for diabetes or prediabetes, which means patients don’t have the chance to learn they can prevent the disease. Diabetes screenings can catch prediabetes because most of the symptoms are similar, but current screening practices have significant gaps. The U.S. Preventive Services Task Force (USPSTF) only recommends diabetes screenings for patients with high blood pressure—not other risk factors such as high body mass index, a sedentary lifestyle, or familial history.

When screenings are happening, they often aren’t effective. When receiving a diagnosis of an “impaired glucose tolerance” or an “impaired fasting glucose level,” many people simply don’t understand the medical jargon and how important it is to change their habits during this early stage, even though they are at high risk for developing diabetes.

Finally, when providers don’t have programs to which they can easily refer patients when testing reveals prediabetes, screenings are far less effective. And other doctors may feel that simply flagging the high risk results will be enough, and that weight loss is the patient’s responsibility.

Where are Innovations Happening?

There are examples of successful pilots and programs that help people at risk for diabetes change their lifestyle in almost all 50 states. The real issue is how to scale these successful programs to meet the growing diabetic pandemic:

• The National Diabetes Prevention Program (NDPP) was originally launched through a partnership between The Centers for Disease Control and Prevention (CDC), the Y-USA, and UnitedHealth Group. Results from the NDPP found that if people at risk for the disease lose 5 to 7% of their body weight and exercise moderately, they can reduce their risk of developing diabetes by up to 58%. In addition, within two years, the reduced cost of treating diabetes and its complications more than paid for the cost of the training. Today, the CDC awards grants to NDPP qualified entities which offer these intervention programs throughout the country.
• Major insurers and large employers are starting to administer diabetes prevention programs as well. UnitedHealth Group, Optum, and Health Medica are all paying for large employers like Albertson's, Cub Pharmacy, Kroger, Rite Aid, Safeway, Shop'n Save, and Winn-Dixie to participate in a year-long program which is based on weekly and monthly group sessions to provide motivational support to keep patients on track with healthy eating, exercise, and behavior modifications.

How Can We Bring Solutions to Sacle?

Public policy can ensure that these diabetes prevention programs are scaled up and widely available to the patients who can benefit from them through the following steps:

• Medicare should pay for prediabetes programs so providers can help patients prevent diabetes through screenings and referrals. Medicare coverage of diabetes prevention programs will allow physicians and other providers to conduct regular screening for prediabetes and give patients a “prescription” for prevention programs when they have prediabetes.
• Medicare and all other health plans—public and private—should also measure and report success with diabetes prevention. Plan performance data based on provider claims—such as Healthcare Effectiveness Data and Information Set performance measures—have proven to be an effective tool in improving screenings, like colorectal cancer screenings.

Potential Savings

The federal budgetary savings from this proposal is $8.2 billion dollars over ten years.