Medicare Expands Lifestyle Program to Fight Diabetes Before it Starts

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Gabbay SuitMost people struggle with their weight and are less active than ever before. Taken together, this toxic lifestyle can lead to serious health problems. The truth is that 86 million American adults—more than one out of three—have prediabetes. What’s scarier is that nine out of 10 don’t know they have it.

Prediabetes is when your blood glucose level is higher than normal but not high enough to be diagnosed as type 2 diabetes. The condition increases your risk of type 2 diabetes, heart disease, stroke and other serious complications such as blindness and kidney failure.

Yet this downward spiral could be averted in the first place, with a change in lifestyle.

People with prediabetes who lose weight by eating healthy and being more active can significantly lower their risk of getting type 2 diabetes. That’s one finding that emerged from the Diabetes Prevention Program (DPP), a landmark research trial that ended in 2000. The study, which Joslin Diabetes Center took part in, showed that people with prediabetes who lost five to seven percent of their body weight and exercised daily reduced their risk of developing type 2 diabetes by over 50 percent.

“We know the potentially devastating aspects of diabetes and that there is an intervention shown to reduce the risk significantly, but we can’t really offer it because there is no coverage for that care,” says Robert Gabbay, M.D., Ph.D., FACP, Chief Medical Officer at Joslin Diabetes Center.

That is changing. The Centers for Medicare & Medicaid Services (CMS) recently announced that they will be expanding the pilot DPP to benefit more Medicare beneficiaries. Beginning in January 2018, the program will be available to older adults with prediabetes or those who have had gestational diabetes and are high risk for developing type 2 diabetes.

Since 2000, numerous programs have taken the principles and protocols of the original Diabetes Prevention Program and embedded them into the community in a variety of ways, says Dr. Gabbay. “This has given us real-world evidence that there is significant potential to improve health, prevent diabetes and reduce long-term medical costs incurred by this disease.”

The DPP is a lifestyle intervention that includes stress reduction, dietary coaching and moderate physical activity. Ultimately, the goal of the year-long program is to prevent the onset of diabetes in individuals who have prediabetes.

“For the first time CMS, is going to be reimbursing for diabetes prevention based on this evidence-based program,” says Dr. Gabbay. “Currently the challenge is that when we identify people who are prediabetic, which is easy to do with a simple blood test, we don’t have a program to enroll them in that is reimbursed.”

While this program will only be available to people 65 and older, what typically happens with health care benefits it that CMS weighs in first, and once they start covering the service, other insurers often follow suit.

“Services like diabetes education and nutrition therapy are examples of services where CMS really helped spearhead the change and commercial payers started covering it,” Dr. Gabbay says. “And I think providers are likely to hone in on it more because they now have a treatment to offer.”

What is unique about this effort is that it is bringing to light the concept that behavior change and a lifestyle intervention is a treatment that is reimbursable, opening the door for similar programs in other areas that will halt or reverse a disease.

What’s more, a number of innovative diabetes prevention programs are looking into using technology, such as digital coaching and telehealth, to help people adopt a healthier lifestyle. From smartphone apps to regular emails, these different technologies give patients easy access to encouragement, reminders and coaching.

Diabetes is a national epidemic. In fact, one third of 15-year-olds today are likely to develop diabetes in their lifetime, says Dr. Gabbay. But a lifestyle intervention like this gives us the ability to turn things around.

“I think this program is going to open things up quite a bit, and not only in the diabetes world, but in other areas as well,” says Dr. Gabbay. “We all look at it as a very hopeful and exciting step forward.”

For help with managing diabetes, contact our Certified Diabetes Educators at 617-309-2780 or make an appointment with our Adult Clinic at 617-309-2440.


One Response to Medicare Expands Lifestyle Program to Fight Diabetes Before it Starts

  1. Pingback: Medicare to Roll Out Diabetes Prevention Program in 2018 – Medscape

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