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."


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