Friday, November 30, 2018

The Diabetes Prevention Program Services May One Day Be Commercially Reimbursed

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) helped lead a study to determine if lifestyle changes could prevent type 2 diabetes. The study was named the Diabetes Prevention Program (DPP). The researchers concluded that a relatively small amount of weight loss, along with healthy eating and physical activity, can prevent type 2 diabetes for those people with prediabetes. The positive results eventually led Medicare, including Medicare Advantage, to start reimbursing suppliers who offer a modified version of the type 2 diabetes prevention program, called the Medicare Diabetes Prevention Program (MDPP). The MDPP might lead to commercial insurer reimbursement for the DPP services.

The Diabetes Prevention Program or DPP trial was started in 1996 by The NIDDK to determine if weight loss promoted by healthy eating and physical activity could be used to prevent type 2 diabetes in persons with prediabetes. The study was a randomized trial consisting of three groups. One of the groups used diet, exercise and lifestyle modification for the prediabetes treatment, one of the groups used metformin for the treatment, and one of the groups was the placebo group. All three groups contained prediabetic subjects that were overweight but not obese. 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 approximately 2.8-year period of the study, 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. 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."

Based on positive results from the original DPP study, Medicare carried out its own test to determine if the DPP methods could be cost effective for Medicare beneficiaries. The DPP was found to be cost effective for Medicare beneficiaries. Therefore, Medicare began offering its diabetes prevention program in April of 2018. The program is called the Medicare Diabetes Prevention Program or MDPP.

And since commercial insurers reimburse for the MDPP under Medicare Advantage programs, these insurers may one day make the DPP services a covered benefit for "commercially insured populations."

Wednesday, November 28, 2018

The EndoBarrier, Obesity and Type 2 Diabetes

G.I. Dynamics of Lexington Massachusetts is the producer of the EndoBarrier. The EndoBarrier is an intestinal liner that mimics some of the functions of gastric bypass surgery. The liner is placed in the stomach, endoscopically, through the mouth. By serving as a barrier in the intestine, the device limits the amount of calories absorbed by the body during digestion. The device aids in the management of obesity and type 2 diabetes.

The “EndoBarrier bridges the gap between pharmaceuticals and surgery by providing a safer and more effective way to control glucose and weight loss for individuals who are underserved by drugs and injections but for whom surgery is not an option.”

While the EndoBarrier could bridge the gap between pharmaceuticals and surgery for the treatment of obesity as well as type 2 diabetes, it may be common, one day, to use the device in combination with pharmaceuticals. In fact, in 2013, G.I. Dynamics said that the company's collaboration with other companies might “lead to improvements in the device, as well as potential combinations of drug treatment and EndoBarrier Therapy to optimize patient outcomes.”

A recent study indicates that the EndoBarrier is an “effective treatment for obesity and type 2 diabetes.” Thirty-one patients completed a 12 month study which showed that there was a weight reduction and a reduction in HbA1c. The investigators concluded that “the EndoBarrier appears to be a safe and effective treatment strategy in overweight patients with poor glycemic control despite medical therapy or in those who are eligible but decline bariatric surgery.”

Healthcare providers should monitor the advances in devices used to treat overweight, obesity and type 2 diabetes. These devices, including the EndoBarrier, will no doubt add to the overweight, obesity and type 2 diabetes treatment arsenals. These devices will indeed fill a gap between pharmaceuticals and surgery. And providers who are well informed will be able to counsel patients on the risks and benefits of the EndoBarrier and other similar devices. 

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