Diabetes Alert Day - March 26th, 2019 | Lark Health

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The fourth Tuesday each March marks American Diabetes Association Diabetes Alert Day. The American Diabetes Association (ADA) and National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) at the National Institutes of Health (NIH) promote this day as a “wake-up call” for Americans. The goals are to raise awareness of the seriousness of diabetes, and to motivate Americans to understand their diabetes risk and to take action if they are at high risk for type 2 diabetes. [1]

Diabetes Alert Day may be targeted to the public, but payors should take heed of this day because they stand to gain from any progress in the fight against diabetes. That is because private insurers pay about 1/3 of medical expenses, estimated at $237 billion annually for diabetes. As the Centers for Disease Control and Prevention (CDC) notes, employers can benefit from increased productivity as diabetes rates go down. [2]

This Diabetes Alert Day, payors can learn about the seriousness of diabetes and what it may be costing them, as well as what they can do about it. A Diabetes Prevention Program (DPP) can lead to better health and lower healthcare costs. In particular, Lark DPP, a digital DPP powered by artificial intelligence (AI), is an infinitely scalable, personalized program that you can offer quickly and easily to your covered population.

Seriousness of Diabetes

Some popular misconceptions can understate the seriousness of diabetes. People may think of it as a condition that their grandparents had to deal with, or they may see it as something so common that it does not seem threatening. The truth is that diabetes is a serious threat to public health and to the economy.

It affects 1 in 8 American adults, including 1 in 6 adults ages 45 to 64 and 1 in 4 adults 65 years and older.[3] These estimated 30 million adults with diabetes are at risk for comorbidities and complications such as high blood pressure and cholesterol, heart disease, stroke, and diabetic neuropathy that can result in amputations, blindness, and chronic kidney disease.

The economic impact of diabetes is also striking. Each patient with diabetes incurs annual medical expenses $7,000 higher than those of a patient without diabetes. Annual indirect costs of lost productivity, such as from absenteeism and presenteeism, total $90 billion.

What can be done about such a costly and forceful disease? Diabetes Alert Day presents the opportunity to learn about and employ a strategy that may be quite effective: prevention. Raising awareness about diabetes and who might be at risk for it can lead to more widespread treatment for people with prediabetes and other risk factors for diabetes.

Prediabetes Risk Factors and the Risk of Developing Diabetes

Most cases of diabetes are type 2 diabetes, which happens with advanced insulin resistance. Type 2 diabetes develops over time as insulin resistance progresses from undetectable to severe enough to cause mildly elevated blood glucose levels. This condition is prediabetes. If insulin resistance continues, blood sugar will continue to rise and type 2 diabetes can eventually develop.

Type 2 diabetes is likely to develop if prediabetes is left untreated. [4],[5] About 5 to 10% of individuals with prediabetes develop diabetes per year, and 37% will develop diabetes within four years. This is an astounding number when considering that 1 in 3 American adults have prediabetes.

However, prediabetes is highly treatable, and most cases of diabetes can be prevented or delayed with simple lifestyle changes, especially weight loss and physical activity. The first step in treatment is to decide to get healthy, and motivation may increase when you understand your diabetes risk.

These are some of the common risk factors for prediabetes and diabetes.

  • Overweight or obese

  • Physically inactive

  • At least 45 years old

  • Pacific Islander, Hispanic/Latino American, American Indian, or African American

  • Have a parent or sibling with diabetes

  • A history of gestational diabetes or gave birth to a baby weighing at least 9 lb.

Despite the importance of treating prediabetes early, only 1 in 10 Americans with prediabetes know they have it. You can understand your diabetes risk better if you ask your doctor for a blood sugar test to see if you have it.

Preventability of Diabetes

Diabetes Alert Day has a grim side as its first purpose spreads the message about the seriousness of diabetes, but there is a hopeful side, too. The second purpose of Diabetes Alert Day is to let people know that type 2 diabetes is largely preventable.

Revisit the figure that 37% of prediabetes cases progress to diabetes within four years. That proportion plummets to 20% when these patients participate in a lifestyle change program. [6] The program need not be complicated to lower risk of developing diabetes. The success of the CDC DPP shows that focus on losing weight and increasing physical activity is enough.

A landmark clinical trial established the potential for lifestyle interventions to prevent or delay diabetes. [7] Researchers compared the effects of a lifestyle intervention program to the effects of the diabetes drug metformin among participants at high risk for diabetes. The lifestyle intervention in the study focused on setting and achieving goals of losing at least 7% of initial body weight and increasing physical activity to at least 150 minutes per week.

Compared to participants in a control group, participants in the metformin group lowered their risk of developing diabetes over the next 2.8 years by 31% and those in the lifestyle change group lowered their risk by 58%. Follow-up research has found that the benefits last for years, with a 34% reduction in diabetes incidence over the following 10 years in the lifestyle intervention group. [8] These impressive results the CDC’s support for the DPP.

How a Diabetes Prevention Program Works

Rather than there being a single nationwide DPP provider, over 1,800 different providers, such as hospitals, community centers, health centers, and private entities, offer a DPP. However, the market for effective and scalable DPPs that meet the security and ease-of-use requirements of payors has quickly consolidated into between 2 and 5 providers who collectively enroll over 95% of participants. All DPPs must:

  • Continue to focus on weight loss and increasing physical activity as did the original study’s lifestyle intervention.

  • Include a year-long curriculum with modules designed to help participants achieve goals.

  • Target individuals with prediabetes and other risk factors for diabetes.

Providers have flexibility in how they present the CDC or CDC-approved curriculum. Some programs, such as Lark DPP, present the curriculum as part of a more comprehensive lifestyle coaching program. Lark DPP emphasizes weight loss and physical activity, but also helps patients prevent or delay type 2 diabetes with additional changes, such as choosing a healthier prediabetes diet, getting adequate sleep, and managing stress.

Why Should You Offer a Diabetes Prevention Program?

The evidence is clear that diabetes is devastating, that many people are at risk for it, and that it is largely preventable with proper intervention. As an evidence-based program that can prevent or delay diabetes, offering a DPP as a benefit can be good for your covered population and for your bottom line.

Cost savings estimates vary depending on variables such as enrollment and completion rates, program cost, and health of the population, but plugging standard values into the American Medical Association (AMA)’s calculator yields a potential 3-year return on investment of up to 42%. [9]

Other reasons to offer a DPP can include:

  • Increased productivity.

  • Reduced employee turnover.

  • Increased awareness of diabetes among families and friends, which is consistent with the goals of Diabetes Alert Day.

  • Preventing a case of diabetes for each estimated 6.9 participants in the program.

How to Implement a Diabetes Prevention Program

How can payors get 50, 100, or 1,000,000 covered individuals or employees who are at risk for diabetes to adapt a healthier lifestyle to prevent diabetes? Patients’ barriers can include lack of awareness of their diabetes risk, the effectiveness of lifestyle changes, and how to make those changes. Payors may not know how to offer and engage participants in an effective program.

The CDC offers a solution in its Diabetes Prevention Recognition Program (DPRP). [10] The program allows for the effective implementation of a DPP, since all DPP providers who meet DPRP standards must meet specific process and outcome criteria.

Organizations such as employers or insurers can create their own DPP and apply for CDC recognition in the DPRP, but it can be easier to find a DPP provider that is already part of the DPRP. You can offer it to your covered population who are eligible based on a diagnosis of prediabetes, a history of gestational diabetes, or high risk for diabetes based on the CDC Prediabetes Screening Test. In fact, as part of Diabetes Alert Day, the CDC encourages employees to take the Prediabetes Screening Test to identify the employees at risk for diabetes. [11]

Once high-risk patients have been identified, you can invite them to join the DPP. Lark DPP assists with the identification and enrollment of eligible individuals to relieve the burden on you.

A Feasible Solution with Lark Diabetes Prevention Program

Unlike most programs, Lark’s technology enables coaching that becomes more personalized the more the patient uses it.

As you select a DPP provider, you will want the best one for both you and your covered participants. Lark DPP may rise to the top of the list as you consider that, as of this Diabetes Alert Day, Lark remains the only DPP with a technology-first approach to have achieved full CDC recognition in the DPRP.

The following aspects are important to payors and worth considering as you make your decision.

  • Cost. The ROI is higher when the cost is lower. Lark is the lowest cost DPP despite being among the best in terms of outcomes.

  • Outcomes. The ROI is higher when outcomes are better. Look for a program with published results, such as Lark’s proven weight loss history and ancillary behavior change statistics.

  • Effortless. Lark ships scales and other synced preferred devices directly to patients so start-up is seamless.

  • Scalability. Regardless of the speed of growth or size of the covered population, Lark DPP is ready to provide personalized coaching to each patient.

  • Enrollment. As a covered benefit provided by a multitude of payors and large, self -insured employers, Lark handles the entirety of the enrollment process ‘out of the box’.

Lark DPP capitalizes on the likelihood of better outcomes when patients are satisfied and engaged. Participants in Lark DPP can expect:

  • Unlimited, 24/7 access to their personal health coach through their smartphones.

  • No need for appointments or commuting.

  • Goal setting and tracking, and motivation.

  • Daily and weekly summaries on progress.

  • Instant feedback when logging meals and physical activity.

  • A judgement-free journey through the CDC’s Prevent T2 curriculum and more.

Lark DPP also takes advantage of its cutting-edge partnership with personal genetics company 23andMe to further personalize health coaching based on genetic risk for diabetes.

Time for YOU to Prevent Diabetes

Something must be done to fight the overwhelming and increasing costs of diabetes, which are directly and severely affecting payors. Since the DPP prevents or delays diabetes and may lower healthcare and indirect costs, the only sensible choice is to offer it to covered populations and employees at risk for diabetes. This can be daunting, but you can choose a DPP provider that makes the process easier and more rewarding for you and your covered population.

Download the whitepaper on the Clinical outcomes from older adults in a digital diabetes prevention program to learn about the importance of consumer experience and scalability in a DPP for those over the age of 50.


Can Digital DPP Engage Older Adults? 

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Based on proven engagement and clinical outcomes, Lark’s DPP has obtained Full Recognition status from the CDC, the highest possible clinical status for a DPP. In this paper we describe a study of 360 adults aged 50 to 85 in Lark’s digital DPP. We calculated an average weight loss of 4.3% total body weight at approximately one year since joining the program. There was no statistically significant difference in weight loss between men and women or between age groups. The analysis also found that 22% of participants who were initially class III obese and 27.5% of participants overall dropped at least one BMI category.


 

[1] The National Institute of Diabetes and Digestive and Kidney Diseases Health Information Center. Diabetes Alert Day. https://www.niddk.nih.gov/health-information/communication-programs/ndep/partner-community-organization-information/diabetes-alert-day

[2] Centers for Disease Control and Prevention. Diabetes Alert Day. Diabetes at Work. National Diabetes Education Program. https://www.cdc.gov/diabetes/diabetesatwork/pdfs/alertrightfit.pdf

[3] National Center for Chronic Disease Prevention and Health Promotion, Division of Diabetes Translation. National Diabetes Statistics Report, 2017: Estimates of Diabetes and Its Burden in the United States. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf

[4] Fonseca VA. Defining and characterizing the progression of type 2 diabetes. Diabetes Care. 2009;32 Suppl 2(Suppl 2):S151-6

[5] Tuso P. Prediabetes and lifestyle modification: time to prevent a preventable disease. Perm J. 2014;18(3):88-93. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4116271/

[6] Tuso P. Prediabetes and lifestyle modification: time to prevent a preventable disease. Perm J. 2014;18(3):88-93. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4116271/

[7] Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. February 7, 2002. N Engl J Med. 2002; 346:393-403. DOI: 10.1056/NEJMoa012512 https://www.nejm.org/doi/full/10.1056/NEJMoa012512

[8] Diabetes Prevention Program Research Group, Knowler WC, Fowler SE, et al. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet. 2009;374(9702):1677-86. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3135022/

[9] American Medical Association. DPP cost saving calculator. https://ama-roi-calculator.appspot.com/

[10] Centers for Disease Control and Prevention. Diabetes Prevention Recognition Program: Standards and Operating Procedures. March 1, 2018. OMB No. 0920-0909. https://www.cdc.gov/diabetes/prevention/pdf/dprp-standards.pdf

[11] Centers for Disease Control and Prevention. Diabetes Alert Day. Diabetes at Work. National Diabetes Education Program. https://www.cdc.gov/diabetes/diabetesatwork/pdfs/alertrightfit.pdf

[12] Stein N, Brooks K. A fully automated conversational artificial intelligence for weight loss: longitudinal observational study among overweight and obese adults. JMIR Diabetes. 2017;2(2):e28. DOI: 10.2196/diabetes.8590

Natalie Stein

Exercise, Fitness & Nutrition Expert | Assistant Professor of Public Health