CMS initiated the Diabetes Prevention Program (DPP) with the goal of preventing type 2 diabetes in individuals with an indication of pre-diabetes (click here to read more).  The clinical intervention consists of clinical sessions focused on dietary change and increased physical activity – behavior change strategies that focus on weight control and, in turn, the mediation of diabetes progression. CMS set the primary goal of the expanded model as at least 5 percent weight loss by participants. The National DPP is based on the results of the Diabetes Prevention Program (DPP) study funded by the National Institutes of Health (NIH). The study found that lifestyle changes resulting in modest weight loss sharply reduced the development of type 2 diabetes in people at high risk for the disease.  Another unique feature of the National DPP program is that it expands the types of providers (including pharmacists) who can provide DPP sessions.

Additionally a number of states are following the suit.  Indiana for example initiated a Medicaid DPP effort, albeit, focused on patients with existing diabetes (click here to read more).  Similarly, the Indiana DPP uses an expanded network of providers (again including pharmacists) to provide DPP sessions.

DPPs are the perfect jumping point for pharmacists initiating provider services.  The CDC estimates that 38% of US adults have pre-diabetes, approximately 9% of the US population has diagnosed diabetes and the prevalence of both is increasing rapidly.  Potential patients for a DPP are readily available.

Research  research has demonstrated the efficacy of a diabetes prevention program (DPP) in lifestyle modifications that can prevent or delay the onset of type 2 diabetes among individuals at risk.  Moreover, the COVID pandemic has demonstrated the utility of Telehealth in enhancing the access of clinical services to patients.

In this months blog I review a study by Batten et. al. evaluating the effectiveness of a Telehealth DPP program.   Specifically the authors sought to evaluate the effect of a Telehealth DPP effort on weight and physical activity in patients who completed 12 months of a DPP.  The DPP consisted of a 16 week core curriculum and an 8 month maintenance period.  To qualify for analysis a patient had:

• to score ≥9 on the online CDC prediabetes screening (or ≥5 on the American Diabetes Association risk screening tool),
• have a pre-diabetes diagnosis (self reported blood test within the last 12 months),
• have a BMI of ≥25 kg/m² (≥23 kg/m² if self-identified as Asian),
• to be ≥18 years of age,
• to indicated a willingness to record their weight throughout the DPP,
• to have a smartphone with an up-to-date operating system,
• regular access to Wi-Fi,
• enrolled in the program between October 2017 and October 2018,
• never previously participated in the program;
• not been diagnosed with type 1 diabetes, type 2 diabetes, or end stage renal disease,
• not been pregnant at the time of enrollment, and
• complete at least 9 months of the 12 month program

The evaluated population consisted of 1095 adults with pre-diabetes.  The patient population was 67.7% (n=741) female and had a mean age of 53.6 years.

The mean starting weight of the evaluated patients was 204.5 lbs, and after 12 months mean weight had decreased to 191.4 lbs, a reduction of 11.4 lbs (5.5%).   Physical activity at baseline was averaged 66.9 minutes per week and after the 16 week core curriculum physical activity increased to 154.9 minutes per week (the CDC recommends that physical activity exceeds 150 minutes per week).  The authors did find that physical activity dropped off to 132.94 minutes per week during the maintenance period.  Regardless patients did ultimately improve their physical activity by 88 minutes per week from baseline.  Increases in physical activity were significantly associated with weight loss.

The results from this study indicate that a Telehealth DPP can be effective in decreasing weight and increasing exercise.  In addition, it would appear that the effects of the DPP endure through the maintenance phase of the DPP.   The study did have a number of limitations which warrant further research.  First the retrospective study design allows for patient selection bias.  It should be noted that 62% of the patient participants were white, questioning the generalizability of the results to other ethnicities.  In addition, patients required their own smartphones and internet to participate which may have lead to selection bias in the results.  Regardless, the results were sufficiently promising that a prospective study is warranted to attempt to replicate these results.

Best – Jim
Jim Notaro, RPh, PhD
Founder and Chief Clinical Officer