A Need for a More Restrictive Diabetes Prevention Program Inclusion Criteria

Prediabetes affects approximately 88 million adults in the U.S. And most of these people don’t know they have the condition. So, to some extent, there is a lack of treatment for prediabetes because of a lack of knowledge. Further, the inclusion criteria used to refer individuals to a National Diabetes Prevention Program (National DPP) may need some modification. The current National DPP inclusion criteria may not be restrictive enough to realize the optimum value from the prediabetes treatment.

A recent study, using simulation methods, looked at how placing restrictions in the National DPP inclusion criteria, similar to those used in the DPP trial, may improve the value of the DPP services.

The researchers, performing the study, concluded that the three-year risk of developing type 2 diabetes in the National DPP eligible population ranges from 1% to more than 90%. This means that the National DPP treats individuals who have very little risk of progressing to type 2 diabetes.

The researchers suggested that comparing the original DPP trial inclusion criteria with the National DPP inclusion criteria shows a loosening of National DPP restrictions. For example, in the DPP trial, the criteria did not include HbA1c measurements, whereas the National DPP does. The National DPP also allows participation from individuals starting at 18 years of age, where the DPP trial's starting age was 25. The National DPP allows participation by persons who had gestational diabetes, where the DPP trial did not.

To be included in the DPP trial, an individual had to have "Impaired glucose tolerance (fasting plasma glucose 95-125 mg/dL and 2hr plasma glucose 140-199 mg/dL)" These criteria are more restrictive than the criteria used by the National DPP.

The researchers determined that being more restrictive in the National DPP selection process would be more beneficial. Specifically, the researchers concluded that “Targeting active diabetes prevention to patients at highest risk could improve health outcomes and reduce costs compared to providing the same intervention to a similar number of patients with pre-diabetes without targeted selection."

Primary care organizations, offering Diabetes Prevention Programs, might want to place more restrictions on candidates for DPP programs. This might improve outcomes and lower cost.

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