Healthcare Cost for Type 2 diabetes

The National Diabetes Prevention Program (National DPP) services can prevent or delay type 2 diabetes for individuals with prediabetes. The National DPP services include help with healthy diet, physical activity, and lifestyle modification. In delaying or preventing type 2 diabetes, the National DPP services can reduce healthcare costs.

Reducing healthcare costs is a significant concern with respect to diabetes. And since older people incur more healthcare costs, in general, one recent study looked at the cost of providing healthcare services to people with type 2 diabetes who were over 65. The CMS version of the National DPP, called the Medicare Diabetes Prevention Program, or MDPP, addresses diabetes prevention for Medicare beneficiaries, the majority of which are over 65 years of age.

In research conducted in Finland, investigators looked at "electronic patient records" to find people over 65 who had been told they had diabetes. After a selection process, 187 people with diabetes and 176 people without diabetes were chosen for the study. Information on how often primary care was used by the chosen participants was taken from electronic patient records for a one-year period.

It was found that, after a year, individuals with diabetes had more doctor's appointments, nurse's appointments, lab work done, and inpatient care at the community hospital than patients without a diagnosis of type 2 diabetes.

The older persons with type 2 diabetes who participated in these healthcare activities paid more for healthcare. In fact, the CDC reports that the average person with diabetes spends $16,750 a year on medical expenses. That is roughly 2.3 times what someone without diabetes would spend on medical care.

The National DPP and the MDPP (to some extent) are public-private arrangements that offer type 2 diabetes prevention services in healthcare and community settings. The National DPP and MDPP have been shown to decrease healthcare cost by delaying or preventing type 2 diabetes. To adequately address diabetes and type 2 diabetes prevention, healthcare providers should either offer treatment services or refer patients to community or healthcare organizations offering the services. 

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Tags: environmental scanning, balanced scorecard, business planning, strategic management, bariatric industry analysis, weight loss industry analysis, weight management industry analysis, prediabetes

Handgrip Strength as a Predictor for Prediabetes

The commonly accepted definition of prediabetes, in general, is as follows: prediabetes is when an individual has abnormally high blood glucose, but the blood glucose is not high enough to be called diabetes. Prediabetes may affect the body in many ways. For example, according to a study done in India, prediabetes is associated with unwanted changes in handgrip strength. And a change in handgrip strength may come before the prediabetes. Indeed, one study, looking at subjects in Japan, indicates that handgrip strength could be an independent predictor of prediabetes.

In the India study, 200 subjects were examined. One hundred of the subjects had prediabetes and 100 had normal blood glucose. The researchers measured the handgrip strength of all subjects.

After crunching the data, the researchers found that the handgrip strength was approximately 12% less for the subjects with prediabetes compared to the subjects who had normal blood glucose.  So, handgrip strength decreased with prediabetes.

In the Japanese study, mentioned above, decreasing handgrip strength was shown to be a possible predictor of prediabetes. In the study, the researchers investigated 1075 subjects who had no prediabetes or diabetes. The researchers measured the handgrip strength of the subjects to obtain baseline measurements.  And the researchers used the handgrip strength measurements to calculate the relative handgrip strength. The relative handgrip strength is defined as "absolute handgrip strength (kg) divided by BMI (reported as kg/BMI)."

After two years of follow-up, the researchers concluded "that lower baseline relative handgrip strength predicted a higher risk of prediabetes incidence among the participants." The researchers stated that "relative handgrip strength predicted a lower and significant risk of prediabetes incidence among individuals with normal weight" as defined by a BMI between 18.4 and 25.

Therefore, handgrip strength measurements could be taken in healthcare settings. Those individuals who have low handgrip strength measurements could be examined for other indicators of prediabetes. And for those with prediabetes or a high risk for diabetes, appropriate interventions could be made.  

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Tags: environmental scanning, balanced scorecard, business planning, strategic management, bariatric medicine, prediabetes, medical practice start up, National DPP, weight management industry analysis

The Diabetes Prevention Program Services Are Commercially Reimbursed

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) sponsored a study to determine if lifestyle changes could prevent or delay type 2 diabetes. The study was called the Diabetes Prevention Program (DPP) trial. The researchers concluded that a relatively small amount of weight loss, along with healthy eating and physical activity, can prevent or delay type 2 diabetes for people with prediabetes. Based on the trial's results, the National Diabetes Prevention Program, or National DPP, was started and led by the CDC. However, there was very little reimbursement by commercial insurers for the program. However, today, there are a number of commercial insurers reimbursing for the program.

The Diabetes Prevention Program or DPP trial was started in 1996. The trial ended in 2001. The trial was a randomized study consisting of three groups. One of the groups, called the Intensive Lifestyle Intervention group, used diet, exercise and lifestyle modification for the prediabetes treatment. One of the groups, called the Metformin group, used metformin for the treatment. And one of the groups was the Placebo group which was treated with usual care approaches. To be included in the trial, a person had to have a BMI of at least 24, except for Asian American, who needed a BMI of at least 22. Results from the study were reported in 2002.

The specific goal of the study was to determine if individuals with prediabetes could avoid type 2 diabetes by losing 7% of their weight through diet, exercise, and lifestyle modification. During the average 2.8-year period of the study's participants, it was concluded that the intensive lifestyle group experienced a 58% reduction in the incidence of type 2 diabetes, and that the metformin group experienced a 31% reduction, compared to the placebo group. And after ten years, the type 2 diabetes incidence "was reduced by 34% ... in the lifestyle group and 18% .. in the metformin group compared with placebo."

And Medicare did its own study to see if the National DPP services would benefit Medicare beneficiaries. The study did show that Medicare beneficiaries could benefit from the National DPP services, so Medicare started the Medicare DPP or MDPP in 2018, with reimbursement for the DPP services. And today, a number of commercial insurers are reimbursing for the National DPP.

 

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CMS Has Made Improvements to the Medicare Diabetes Prevention Program

The Medicare Diabetes Prevention Program (MDPP) is an example of evidence-based Lifestyle Medicine (LM) methods that are being used to prevent and delay type 2 diabetes. And for 2024, CMS made changes to the MDPP to make the MDPP easier to navigate by the providers, more flexible, and more effective. After receiving much criticism concerning the MDPP, and after gaining experience during the COVID-19 PHE, CMS made changes to the MDPP to synch the program more with the National Diabetes Prevention Program (National DPP).

And if organizations, that provide the MDPP, structure their delivery process using the low-cost, group-based, evidence-based, DPP-coach-delivery model the National DPP is built on, the organizations can receive reimbursement that more than covers the cost of delivery (typically $400.00 to $500.00 per participant).

In the new rules, CMS added a DPP asynchronous virtual delivery option. And the pay structure is fee-based and value-based. The number of G-codes has been reduced from 15 to 6. There is one G-code for in-person attendance, and one G-code for virtual attendance.

The new reimbursement amount for an in-person or virtual attendance will is $25. There is a G-code for a 5% weight loss, with a reimbursement payment of $145. When an MDPP participant attends all 22 sessions, the MDPP provider will receive a payment of $550.00. When an MDPP participant attends all 22 sessions and reaches all weight loss milestones, the provider will receive $768.00.

There were changes to the proposals, but because of criticism, lessons learned during the PHE, and the desire to prevent or delay type 2 diabetes for Medicare beneficiaries, CMS made the above changes to the MDPP.

The American Medical Association has been endorsing and promoting the National DPP for some time. And if you are interested in determining what might be your cost to deliver the National DPP or the MDPP, you can use the Budget Tool that the AMA offers. 

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Treating Depression as a Preventative Measure for Diabetes

Depression and diabetes are two prevalent health issues that often coexist, creating interconnected challenges for individuals. Recent research has discovered a connection between the two conditions, suggesting that treating depression could play a role in preventing diabetes.

Studies have consistently shown a bidirectional relationship between depression and diabetes. Individuals with diabetes are at a higher risk of developing depression, and those with depression have an increased susceptibility to diabetes. This link is not merely coincidental; shared biological mechanisms and lifestyle factors contribute to the intricate association between the two conditions.

Chronic inflammation is a common denominator in both depression and diabetes. Depressive symptoms can trigger inflammatory responses in the body, leading to an imbalance in immune function. This chronic inflammation, in turn, contributes to insulin resistance and impairs the body's ability to regulate blood sugar levels, increasing the risk of diabetes.

Persistent stress is a well-known contributor to both depression and diabetes. The body's response to stress involves the release of cortisol, a hormone that, when elevated for prolonged periods, can lead to insulin resistance. By addressing and treating depression, individuals may effectively manage stress levels, reducing the impact on cortisol secretion and, consequently, mitigating the risk of developing diabetes.

Depression often leads to unhealthy lifestyle choices, such as poor diet, sedentary behavior, and irregular sleep patterns – all of which are risk factors for diabetes. Treating depression involves not only addressing the emotional aspects but also promoting healthier habits. Encouraging individuals to adopt a balanced diet, engage in regular physical activity, and establish a consistent sleep routine can significantly contribute to preventing diabetes.

Mental health treatment, including therapy and medications, can provide individuals with the tools to cope with depression effectively. As the emotional burden lessens, the associated physiological changes, such as reduced inflammation and cortisol levels, may contribute to a decreased risk of developing diabetes.

The link between depression and diabetes emphasizes the need for a holistic approach to healthcare. Treating depression is not only essential for improving mental well-being but may also serve as a preventative measure against the development of diabetes. By addressing the connection between these conditions, healthcare professionals can empower individuals to lead healthier lives.

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Adapting the CDC's National Diabetes Prevention Program Services to the Hearing Community

 
The National Diabetes Prevention Program (National DPP), a CDC-led lifestyle modification program that assists participants in losing weight, increasing physical activity, and adopting healthy eating habits, is one of the most successful therapies for preventing or delaying type 2 diabetes. The delivery of the National DPP can take place digitally, in person, or in a hybrid format. And since diabetes has a significant impact on the deaf population, a modified version of the program that focuses on enhancing communication may be beneficial and well-received by the deaf community.

"Deaf individuals who communicate using American Sign Language (ASL) are three times more likely to have diabetes than hearing people," said the American Diabetes Association. Insufficient communication is a large part of the problem.

A German study titled "Primary non-communicable disease prevention and communication barriers of deaf sign language users: a qualitative study" focused on the issue of insufficient communication. One of the study's conclusions is as follows: "In order to develop effective diabetes and non-communicable disease prevention strategies for deaf sign language users, health care professionals need to consider sign language specific communication concepts." The National DPP might be helpful here.

National DPP sessions are available all around the country and have to meet CDC-established requirements for quality. The Diabetes Prevention Recognition Program (DPRP) was created by the CDC to single out institutions that provide the National DPP and meet quality standards. The CDC provides a complete list of the programs approved by the CDC. Using the list, which contains location information, can enable deaf community members to approach National DPP managers to discuss potential partnerships.

The following program may be of interest to those who wish to modify the National DPP to accommodate the needs of the deaf and hard of hearing community. The program is the "Diabetes Prevention Program for Deaf and Hard of Hearing."

The deaf community is in need of type 2 diabetes prevention and delay. The National DPP is a good place to start. 

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Prediabetes and Dementia

Prediabetes is a condition in which blood glucose levels are elevated but not high enough to be identified as diabetes.   More than 98 million Americans have prediabetes, according to the Centers for Disease Control and Prevention (CDC), yet the majority are unaware of it.   Prediabetes raises one's chances of acquiring type 2 diabetes, which is a major risk factor for cardiovascular disease and stroke.  Furthermore, prediabetes can harm your brain function and raise your chance of dementia.

Dementia is a broad term describing a deterioration in cognitive processes that interferes with daily living, such as remembering, thinking, and reasoning.   The most frequent cause of dementia, accounting for 60% to 80% of cases, is Alzheimer's disease.  Vascular dementia, Lewy body dementia, frontotemporal dementia, and mixed dementia are some of the other causes. Dementia affects around 50 million people globally, with that figure estimated to climb to 152 million by 2050.

One study has shown that prediabetes is associated with dementia risk. Researchers indicated that that there was a significant longitudinal association between increased levels of HbA_1c "long-term cognitive decline." Another study showed that "Prediabetes can also increase the risk of dementia because it is associated with an increased risk of heart disease, stroke, and other cardiovascular diseases."

The good news is that by making simple lifestyle changes, including losing weight, eating a nutritious diet, exercising frequently, and stopping smoking, prediabetes can be corrected or prevented from advancing to diabetes. These healthy changes may also reduce the risk of dementia. Hence, it is critical to get tested for prediabetes and take action to avoid the negative implications of more harmful conditions such as diabetes and dementia.

Therefore, physicians and other healthcare clinicians should make screening for prediabetes an integral part of periodic patient examinations. Not only will the examinations help prevent or delay type 2 diabetes, but the examinations might lower the risk of dementia.

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