Three steps to implement a diabetes prevention strategy for your patients.

 

Patients at risk for type 2 diabetes may head down a path that’s difficult for them to navigate in the future. However, a systematic process for diabetes prevention can help patients take control of and improve their health.

The National Diabetes Prevention Program lifestyle change program (National DPP lifestyle change program) has been proven to help patients delay or prevent type 2 diabetes. Over the past few years, the Centers for Disease Control and Prevention (CDC), the American Medical Association (AMA), and healthcare organizations across the nation have worked together to bring National DPP lifestyle change programs to patients.

The following three steps can help you identify patients with prediabetes and refer them to a National Diabetes Prevention Program lifestyle change program.

Step 1: Identify patients with prediabetes

Patients who would benefit from a laboratory test for prediabetes can be identified before their office visit. You can have patients complete a prediabetes risk test and/or arrange for testing to occur before a scheduled appointment. For patients who have had a recent laboratory test, you can use your electronic health record (EHR) to identify those who meet the diagnostic criteria for prediabetes. The three laboratory tests used to diagnose prediabetes are the hemoglobin A1C, the fasting plasma glucose and the oral glucose tolerance test. The diagnostic ranges for normal glucose, prediabetes and type 2 diabetes are noted in the figure below:

Once patients with prediabetes have been identified, patients should be informed of their diagnosis and this diagnosis should be documented in their chart. You can use the ICD10 code R73.03 to document prediabetes.

Step 2: Provide patients with evidence-based treatment

The next step is to ensure patients with prediabetes receive evidence-based treatment to reduce their risk of developing type 2 diabetes. The most effective treatment option for patients is lifestyle change, and this can be achieved through participation in the National DPP lifestyle change program.

This structured and intensive year-long program is led by a trained coach that gives participants the knowledge and skills to make healthy lifestyle changes. Individuals participate in group sessions that take place on a weekly basis for the first six months of the program and then transition into a maintenance phase, which consists of monthly sessions. The curriculum is comprehensive and includes topics on healthy diet and physical activity, as well as sessions that focus on stress management and behavioral strategies to make lasting change. The CDC provides oversight of the National DPP lifestyle change program and maintains standards for program sites to receive approval and recognition. Contact information for all CDC-recognized organizations that deliver evidence-based type 2 diabetes prevention programs in communities across the United States is available through a national registry maintained by the CDC.

Step 3: Monitor and follow-up

If you refer patients to a National DPP lifestyle change program, it is recommended that you monitor their progress and follow-up on their outcomes to help support them. A process should be established with the provider of the National DPP lifestyle change program to share regular updates about participation and achievement of goals for patients in the program. It is recommended that communication occur at designated points during the program, such as 4, 9 and 16 weeks and at the time of completion. This will also allow you to arrange any appropriate follow-up visits or repeat laboratory testing for patients.

By using these three steps, you can help your patients reduce their risk of developing type 2 diabetes and make them aware of the National DPP lifestyle change program. As a result, you empower your patients to improve their health and provide them with the skills and strategies to make long-term healthy lifestyle changes.

For more information, consult the Prevent Diabetes STAT toolkit, which includes patient identification/management protocols, referral templates and patient awareness materials.