Diabetes Forecast

Diabetes Prevention Works Out at the YMCA

A national effort show results in preventing type 2 diabetes

By Erika Gebel, PhD ,

From left, Belen Bryan, Karen Robinson, and Sandi Hunter are graduates of the diabetes prevention program at their local Y.

Prediabetes is a big problem in search of a big solution. This condition often leads to type 2 diabetes, and 79 million Americans have it. Yet there is a big solution at hand: the Diabetes Prevention Program (DPP), a course that teaches people how to eat healthfully and find time to exercise.

There's scientific proof that the DPP can prevent or delay type 2 diabetes. Now the challenge is to bring the program to the millions who need it. A group of people from places such as Indiana University, the YMCA, the Centers for Disease Control and Prevention (CDC), and UnitedHealth Group have teamed up to do just that.

The 7 Percent Solution

The Diabetes Prevention Program study had people with prediabetes meet one-on-one with health care providers in clinical settings. The goal: to lose 7 percent of their body weight by changing their approach to food and exercise. The 16-week program included weekly one-hour sessions on topics such as reading food labels, dealing with stress without overeating, and increasing physical activity to 150 minutes a week. Monthly refresher sessions helped maintain results. DPP participants:
♦ lost an average of 5 percent of their body weight.
♦ lowered their risk of developing diabetes by 58 percent compared with a control group.

A decade ago, no one knew how to thwart the development of type 2 in people at high risk. "The conventional wisdom at the time was that weight loss isn't effective" in combating type 2, says David Marrero, PhD, professor of medicine at Indiana University and a member of the Diabetes Forecast editorial board. Marrero and collaborators put together a large study (also called the Diabetes Prevention Program) to answer once and for all whether lifestyle changes could help fend off type 2. The DPP results, published in 2002, were a big success (box, right). "Lifestyle change became the most potent method to prevent or delay the onset of diabetes in high-risk people," says Marrero. Then the question became how to bring the program to the people who need it.

Success Story

Karen Robinson, 64, recently graduated from a DPP class at a local Y in the Washington, D.C., area. She signed up after her doctor said she would need to take medication for her prediabetes. "That got my attention, because the last thing I want to do is take another pill," she says.

By the end of the four-month program, she'd reached her goal weight. The DPP gave Robinson the tools to make healthy eating decisions. "I've learned that when I go to my favorite restaurant a couple of times a year, to maybe get a smaller-size [crab cake] and have green beans instead of a baked potato," she says.

The ADA and the DPP

The American Diabetes Association (ADA) has supported the Diabetes Prevention Program (DPP) from the beginning. The Association provided funding for the original landmark trial that established for the first time that type 2 diabetes could be prevented or delayed through lifestyle changes. What's more, the ADA worked with members of Congress to get language into the Patient Protection and Affordable Care Act, the 2010 health care reform law that authorized establishment of the National DPP. Today, Association advocates continue to work to ensure the program is fully funded.

The program works because it's logical, says DPP researcher Marrero. "It's not a diet. It's a way to approach how you eat and incorporate food and physical activity into your life."

The YMCA's course, known as the YDPP, is delivering the program effectively at a reasonable cost. The original DPP was too expensive for broad access, at $1,400 a year per participant. The Y program has cut costs dramatically by offering group classes and by training community members as lifestyle coaches to teach the course. The new way of delivering the DPP is getting results as good as the original—at a quarter of the cost. Plus, the coaches can bring the YDPP to locations beyond the 47 metro area YMCAs that now offer it. "We can come to where you are," says Irmina Ulysse, the program's director for the YMCA of Metropolitan Washington. "We just need 15 people and a spot."

The Next Steps

The YDPP and similar efforts are now part of a grander scheme called the National Diabetes Prevention Program. Spearheaded by the CDC, it was created as part of the 2010 health care reform law. "We have got to have a public-health impact in diabetes prevention," says Ann Albright, PhD, RD, director of the CDC's Division of Diabetes Translation. The nation can't have just a few people access this prevention program, she says.

Finding ways to pay for the DPP is a big part of the CDC's push. The program's cost has been slashed, but the typical $350 to $500 fee is still a hurdle for people with prediabetes. Enter the health insurance industry. The major insurer UnitedHealthcare already covers the program for more than 2 million policyholders. Four other insurance companies are soon to join the effort, says Deneen Vojta, MD, senior vice president and chief clinical officer of UnitedHealth Group. Medicaid recipients in the New York City area have DPP coverage, too.

"We pay for what works," says Vojta. One analysis of the original DPP showed that medical care for the average participant cost $2,600 less over the 10 years following the program than care for those in a group that didn't take DPP classes.

The National DPP is expanding rapidly, although it's still not available everywhere. You can ask your local Y if it offers the program and find out if your health plan covers it. If not, suggest that your employer add it to your group plan.

The CDC's Albright is hopeful about the power of the program to prevent or delay diabetes. "We do a disservice to the investment in research if we don't bring it to people," she says. "Taking that science from its original discovery to widespread implementation—that's what we're here to do."



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