A Sentinel Network for Evaluation of the Reach, Implementation, Effectiveness, and Costs of Evidence-Based Lifestyle Interventions to Prevent Type 2 Diabetes in U.S. Adults

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Project Summary Despite tremendous advances in diabetes, Type 2 diabetes (T2D) is a leading cause of preventable death and disability in the U.S., and more than 1.5 million more Americans develop T2D every year. More than half of those new cases could be prevented or delayed if high risk adults were offered resource-intensive lifestyle intervention programs while they have prediabetes – a readily identifiable stage of abnormal glucose metabolism that precedes the development of type 2 diabetes. Currently, 88 million Americans have prediabetes, but about 5 in 6 of them is unaware, and fewer than 1% have participated in an intensive lifestyle intervention. CDC created the National Diabetes Prevention Program (NDPP) to address the increasing burden of type 2 diabetes in the United States. The NDPP lifestyle change program is offered through CDC recognized organizations, including community-based organizations, hospitals, provider groups, pharmacies, and health plans in a variety of delivery approaches (in person, online, remote classroom or telehealth). Since 2018, the Medicare Diabetes Prevention Program (MDPP) has also offered a structured lifestyle intervention program designed to prevent type 2 diabetes in individuals 65 years and older with prediabetes. We propose to develop and implement a collaborative research data collection and evaluation plan that emphasizes the unique, complementary strengths of several organizations with experience supporting the delivery of National DPP and/or Medicare DPP interventions to reach diverse populations in multiple contexts and in multiple formats. Our proposal will integrate several sources of data needed to successfully evaluate participation barriers and facilitators, effectiveness, costs, and cost-effectiveness of efforts to implement evidence-based diabetes prevention services as part of the NDPP and MDPP. In collaboration with large health systems and DPP suppliers in several representative “sentinel” locations nationally, we will collect, manage, harmonize, and analyze multiple data sources, including: (1) health system partner data regarding participant eligibility characteristics, participation barriers and facilitators, and change in biometric outcomes over time; (2) NDPP supplier data regarding attendance levels, weight changes, participant experience, and implementation challenges; and (3) large health payer data for traditional Medicare beneficiaries nationally, UnitedHealthCare (UHC) commercially ensured health plan enrollees nationally, UHC Medicare Advantage enrollees nationally, and UHC Medicaid Managed Care enrollees in select states that participate in NDPP.