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Medicare finally embraces a proven diabetes prevention program

Medicare finally embraces a proven diabetes prevention program

In an exciting development for diabetes patients and their doctors, Medicare will likely soon begin providing coverage for the Diabetes Prevention Program.

The Diabetes Prevention Program is a 16-session lifestyle program taught over 24 weeks for those with pre-diabetes. The goals include a 7 percent weight reduction through the promotion of a healthy low fat diet and physical activity (at least 150 minutes per week). The curriculum covers “diet, exercise, and behavior modification ... [and is] taught by case managers on a one-to-one basis during the first 24 weeks [followed by] individual sessions (usually monthly) and group sessions ... to reinforce the behavioral changes,” according to the “Handbook for Health Pyschology.”

We find the program particularly exciting because not only has it been proven to work in a high quality randomized trial, but it is more effective than metformin, another form of treatment for controlling blood sugar levels. The intervention has been shown to reduce the incidence of diabetes over 3 years by 58 percent versus a reduction of 31 percent with metformin.

Why might Medicare finally begin covering the Diabetes Prevention Program? In 2012, the Centers for Medicare and Medicaid funded the YMCA to study the program in “real-world" settings. The YMCA utilized unlicensed community health workers — rather than licensed staff — to lead the interventions. According to Health and Human Services Secretary Sylvia Burwell, a yet-to-be published evaluation showed that the program reduced health care costs by as much as $2,650 per enrolled individual over 15 months and prevented diabetes. And under a new provision within the Affordable Care Act, Burwell has the authority to expand programs that the Medicare actuary deems to lower overall costs of care without compromising quality without requiring Congressional approval. While we await publication of these findings so that we can review them, it certainly sounds encouraging!

A final point: We certainly appreciate Medicare’s cautious approach in deciding whether to cover the program. It took 14 years after publication of the initial high quality efficacy trial, and several successful “real-world” studies, before the decision was made.  

This is certainly consistent with the “Slow Medicine” approach. But it also begs the question: Why isn’t Medicare this cautious about approving coverage of expensive new pharmaceuticals and procedures?

[Photo by Bill Marrow via Flickr.]


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