Friday, August 28, 2020

Reimbursement for the Medicare Diabetes Prevention Program Should be Increased

Based on positive results from the Diabetes Prevention Program (DPP) study carried out between 1996 and 2002, Medicare started offering a version of the Diabetes Prevention Program to Medicare beneficiaries in April 2018. The program is called the Medicare Diabetes Prevention Program (MDPP). However, there are currently very few MDPP providers in the U.S. That means that many Medicare beneficiaries don’t have access to an MDPP. One reason for the limited number of MDPP providers is the cost of delivering the program. The cost is often more than the Medicare reimbursement. MDPP reimbursement should be increased to entice more providers to offer the MDPP.

The DPP study showed that the intensive lifestyle intervention (ILI) employed in the study could lower the risk of type 2 diabetes by 58% for people with prediabetes. But more importantly, the study showed that for persons over 60, the risk reduction was 71%. Because of the DPP study results, CMS carried out its own test.

The CMS investigators concluded that by using the DPP methodology, Medicare could save $278 per participant per quarter of each year. Because of the savings, Medicare started offering the MDPP in April of 2018. However, a study published on June 12, 2020, indicates that MDPP providers are in short supply. For example, In July 2019, it [was] estimated that there was one MDPP “site per 100,000 Medicare beneficiaries nationwide.”

One of the reasons for the lack of MDPP providers is the cost of delivering the program compared to the Medicare reimbursement. For example, in 2019 the maximum reimbursement was $470 per participant for the first MDPP year, while the cost of delivering the program was typically in excess of $500 per participant per year.

So adjustments should be made in the MDPP reimbursement to attract more MDPP suppliers. If adjustments are made in the reimbursement that improve return-on-investment (ROI), providers will see that they can improve the health of their patients while realizing a net income.

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Tuesday, August 25, 2020

Counseling for Prediabetes Should be Heightened in Primary Care

Prediabetes is a condition where an individual’s blood glucose is abnormally high, but not high enough to be called type 2 diabetes. But prediabetes raises the risk of type 2 diabetes. Because of the nature of prediabetes, a healthcare provider -- especially one in a primary care setting -- can collaborate with the patient to determine if there is a need to treat the condition. Being over 40 years of age, overweight or obese, for example, can raise the risk of type 2 diabetes in a patient with prediabetes. If the patient is at high risk of getting type 2 diabetes, the provider should counsel the patient or make a referral.

The provider should counsel the patient on ways to make lifestyle changes to treat the prediabetes, or refer the patient to an organization that can provide the counseling. While the referral rate for prediabetes treatment is unknown, counseling for prediabetes in a primary care setting is relatively low. The level of counseling for prediabetes should be increased.

Approximately 88 million adults in the US have prediabetes. And the CDC’s Diabetes Prevention Program study has shown that addressing prediabetes using intensive lifestyle intervention (ILI) can reduce the incidence of type 2 diabetes. Based on the results of the Diabetes Prevention Program  study, the CDC established the Diabetes Prevention Program (DPP) to help individuals treat prediabetes.

Counseling high risk patients with prediabetes or referring the patients to an organization that offers prediabetes counseling is recommended by the US preventive services task force (USPSTF) . However, one study showed that only about 40% of patients with prediabetes were counseled by a healthcare provider to control or lose weight, increase physical activity, or decrease the fat or calories in the diet.

The investigators further stated that “participants who were counseled to adopt healthy lifestyle reported high adherence to weight control and diet modification.” So while ILI, used by the DPP, can reduce type 2 diabetes cases by treating prediabetes, providers often don’t counsel patients who have the condition.

Since patients are more often in a primary care setting than any other healthcare setting, primary care providers can be an important factor in helping to decrease the number of type 2 diabetes cases by counseling patients who have prediabetes.

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Tuesday, July 21, 2020

The Benefits of a Plant-Based Diet in Combating Cardiovascular Disease

There is a lot of talk today about plant-based diets, and how they appear to be beneficial in combating many chronic diseases, including obesity, high blood pressure, chronic kidney disease, and cardiovascular disease (CVD). With respect to CVD, people following a plant-based diet may have less heart disease than those following a diet that includes animal products. Even people who have a high genetic risk of CVD can benefit from a plant-based diet.

First of all, what exactly is a plant-based diet? Depending on who you talk to, a plant-based diet can be anything from a semi-vegetarian diet, consisting of very small portions of animal products, to a vegan diet, consisting of absolutely no animal products. At any rate, compared to diets that include animal products, plant-based diets appear to be significantly helpful in the treatment of CVD, and for lowering a person's risk for high blood pressure, diabetes and other unhealthy conditions.

In another study, it was found that “high animal protein intake was positively associated with cardiovascular mortality and high plant protein intake was inversely associated with all-cause and cardiovascular mortality, especially among individuals with at least 1 lifestyle risk factor."

The benefits of a plant-based diet are even evident for those people who have a high genetic CVD risk profile. In a study consisting of 156,148 adult participants, who didn’t have CVD, it was found that adherence to a plant-based diet gradually decreased the risk of CVD even for those who had a high genetic risk of CVD. Indeed, investigators concluded that “adherence to healthy plant-based diets may be associated with a decreased incidence of CVD in the entire population, suggesting that plant-based diet patterns may modify the risk of CVD, regardless of genetic susceptibility.”

Indeed, there are indications that the use of a plant-based diet can improve health, in general, and CVD risk factors in particular. The evidence creates an opportunity for cardiologists and other healthcare providers. Therefore, healthcare providers should learn more about plant-based diets and how to counsel patients on the benefits to be gained from the diet.

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Monday, July 20, 2020

The CDC's Diabetes Prevention Program Methods Can Treat Metabolic Syndrome

Approximately a third of Americans have prediabetes. Prediabetes is a condition where an individual has an abnormally high blood glucose that is not high enough to be called type 2 diabetes. And many experts agree that prediabetes is a predictor of type 2 diabetes.  Metabolic syndrome, which is a cluster of potentially unhealthy conditions that happen together, can also be a predictor of type 2 diabetes. It is estimated that about a third of Americans have metabolic syndrome. And just as with prediabetes, the CDC's Diabetes Prevention Program methods can be used to treat metabolic syndrome.

As was stated above, metabolic syndrome is a cluster of potentially unhealthy conditions. The cluster of conditions may typically include any three of the following: excess belly fat, abnormally high blood glucose (but not high enough to be called type 2 diabetes), hypertension, elevated triglyceride or elevated cholesterol levels. One study suggested that “metabolic syndrome was associated with an increased risk of type 2 diabetes.”

The conditions that usually form the metabolic syndrome cluster are, many times, associated with a lack of physical activity, overweight and an unhealthy lifestyle. Therefore, weight-loss related intensive lifestyle intervention (ILI) consisting of heightened physical activity, diet improvement, and behavioral change may be recommended as a treatment for metabolic syndrome.

This lifestyle treatment includes sessions, for participants, that highlight the importance of engaging in at least 150 minutes per week of physical activity, eating a healthy diet that includes whole-grains, vegetables, fruits, healthy protein and losing and maintaining a healthy weight.

The CDC’s Diabetes Prevention Program (DPP) was put in place to address prediabetes in an attempt to delay or prevent type 2 diabetes. The DPP uses the type of lifestyle sessions described above for treating prediabetes. And one report indicates that the DPP ILI sessions can be used to prevent or delay metabolic syndrome.

Metabolic syndrome and prediabetes can be predictors of type 2 diabetes. Therefore, it is incumbent on healthcare providers to pay close attention to metabolic syndrome and prediabetes. It may also be a good idea to learn how to employ the methods used in the CDC's DPP for possible metabolic and prediabetes treatment.

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Sunday, June 28, 2020

Physical Activity May be Used to Treat or Delay Parkinson's Disease

Parkinson’s disease [PD] is a degenerative neurological disorder affecting approximately one million Americans. According to the Mayo Clinic, “Parkinson's disease is a progressive nervous system disorder that affects movement. Symptoms start gradually, sometimes starting with a barely noticeable tremor in just one hand. Tremors are common, but the disorder also commonly causes stiffness or slowing of movement.” Further, according to the Clinic, "some research has shown that regular aerobic exercise might reduce the risk of Parkinson's disease.” Indeed, one study demonstrated that  physical activity may be used to treat or prevent Parkinson’s disease.

The study's purpose was to examine the effects of physical activity on PD, and to provide "theoretical guidance for the prevention and treatment of PD." For the analysis, the investigators interrogated four databases. The databases were PubMed, Springer, Elsevier, and Wiley database.

After categorizing risk factors and protective factors for PD, the investigators concluded that physical activities were among the protective factors. Those physical activities were "running, dancing, traditional Chinese martial arts, yoga, and weight training." Further, the investigators concluded that " Physical activity has a positive impact on the prevention and treatment of PD."

And according to WebMD, engaging in physical activity can be beneficial when it comes to PD. Physical activity can improve flexibility, balance, walking and hand strength. And physical activity can help with the control of tremors and uncontrolled movements.

Finally, one analysis concluded "that people living with Parkinson's disease can benefit from being physically active, especially when it comes to improving gait and balance, and reducing risks of falls."
And the investigators suggested that health providers should advise their patients with PD to engage in physical activity.

Indeed, physical activity should be a part of everyone's lifestyle. We know that physical activity, along with a healthy diet, and other healthy lifestyle activities, can improve the length and quality of all our lives. And improvement in PD is just another one of the specific ailments that physical activity might bring about.

Friday, June 26, 2020

Liraglutide as a Treatment for Overweight Individuals with and without Diabetes

Liraglutide was approved for type 2 diabetes treatment in 2010. And In 2014, liraglutide was approved for weight loss. Since most people with type 2 diabetes are also overweight or obese, it would seem that liraglutide would be a good candidate medication for treating those overweight or obese persons who don't have type 2 diabetes, and those overweight or obese persons who do have type 2 diabetes. One study has shown the efficacy of treating non-diabetic patients who are obese with liraglutide. And another study has shown the efficacy of treating type 2 diabetes patients who are overweight or obese with liraglutide.

To determine if liraglutide is a good medication for weight loss for persons who are obese, the investigators performed a meta-analysis to determine the efficacy and the safety of the drug for obese patients. In the analysis, five publications from such databases as EMBASE and Medline were studied. The investigators analyzed 4754 non-diabetic  obese patients by comparing the weight loss in a liraglutide group (2,996 participants) with the weight loss in a placebo group (1,758 particip0ants). The liraglutide group lost 5% more weight than the placebo group.

Therefore, the investigators concluded that "liraglutide [is] an effective and safe treatment for weight loss in...  obese, non-diabetic  individuals.”

Many individuals with type 2 diabetes are overweight. And some medications for treating diabetes, including insulin, can cause weight gain. So a study was done to determine if liraglutide can enable a patient to lose weight and also treat type 2 diabetes. The primary objective of the study was to determine if liraglutide (3.0 mg dose) was more effective in treating obese patients with type 2 diabetes than a placebo group.

The study was a randomized controlled study where the liraglutide 3.0 mg group consisted of 198 participants. The placebo group also consisted of 198 participants. All participants in the liraglutide group were subjected to intensive behavioral therapy (IBT).  And all study participants were being treated with basal insulin.

After 56 weeks, the investigators concluded that the liraglutide 3.0 mg group achieved a 5.8% average weight loss compared to 1.5% for the placebo group. The liraglutide 3.0 mg group also had “significantly greater reductions in mean HbA1c, mean daytime glucose values, and less need for insulin versus placebo…”

Based on the two studies above, it can be concluded that liraglutide is an effective medication for obese patients who are either diabetic or non-diabetic.

Monday, May 25, 2020

Weight Loss Through Diet and Exercise for Osteoarthritis

Weight loss through diet and exercise may be an effective treatment for osteoarthritis. Osteoarthritis can result from wear and tear on your joints. The wear and tear can be a consequence of a number of  conditions, including injuries, age or obesity. And weight loss, resulting from diet, exercise, and lifestyle changes, may improve osteoarthritis symptoms.

A past study concluded that "obese individuals have significantly more severe joint degeneration in the knees compared with normal weight or underweight individuals." Furthermore, the investigators indicated that "Weight loss can prevent onset of osteoarthritis, relieve symptoms, improve function and increase quality of life."

In another study, the importance of weight loss was further confirmed. In the study, where 380 overweight men and women were investigated in the ninety-six month analysis, the researchers determined that "cartilage degeneration was significantly lower among people who lost weight through diet and exercise or diet alone." It should be noted, however, that "weight loss through exercise alone showed no significant difference in cartilage degeneration..."

There is evidence that  obesity is a risk factor for  total knee replacement (TKR) caused by osteoarthritis. And in one study, investigators looked at the effects of intentional weight loss on total knee replacement caused by osteoarthritis. Using intensive lifestyle intervention (ILI) methods, the investigators concluded that engaging in "physical activity, dietary restrictions and behavior to lose weight may be "effective in preventing TKR prior to the development of knee pain."

So, weight loss and maintaining a healthy weight can be beneficial in the treatment of osteoarthritis. Healthcare providers should use this evidence based information in counseling sessions. The providers can advise patients that weight loss through diet, exercise and lifestyle changes can improve the symptoms of osteoarthritis. Knowing that there is action that patients, suffering from osteoarthritis, can take to relieve the symptoms of osteoarthritis can be very helpful to the patients. 

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