Saturday, July 30, 2022

Medical Nutrition Therapy Can Improve HbA1c in Children and Adolescents

Prediabetes may be defined as having elevated glucose, but not elevated enough to be called diabetes. Prediabetes is known to sometimes lead to type 2 diabetes. And while for adults,  the progression from prediabetes to type 2 diabetes has received much attention, and is understood to a great extent, the progression of prediabetes to type 2 diabetes in children and adolescents has not received a lot of attention, and the progression is less understood. One study looked at how nutrition, “as a surrogate marker for lifestyle modification,” could affect the progression in children and adolescents over a period of four years. 

The researchers hypothesized that “Adherence to nutrition visits could reduce BMI and lower HbA1c.” The study participants consisted of 108 youths who had prediabetes. There were 46 males with an average age of 12.4, and 62 females with an average age of 13.3. All 108 youths were given medical nutrition therapy every three months after receiving a diagnosis of prediabetes. The study participants were split into two groups – an experimental group and a control group. The experimental group received at least two nutrition visits per year, and the control group received no more than one nutrition visit per year. And while the control group had higher BMI z-scores, both groups had similar HbA1c measurements.

The control group progressed to type 2 diabetes at a faster rate than the experimental group. Eighteen of the control group participants moved on to type2 diabetes by the fourth year, and four of the experimental group participants moved on to type 2 diabetes by the fourth year. The average time it took the participants in the control group to get type 2 diabetes was 25.8 ± 12.6 months. And the average time it took the participants in the experimental group to get type 2 diabetes was 34.9 ± 11.8 months.

The researchers concluded that “Adherence to nutrition visits was associated with a 4-fold reduction in the likelihood to progress from prediabetes to T2D in US youth.” Indeed, nutrition should play a significant role in the treatment of prediabetes in children and adolescents, just as it does in the treatment of prediabetes in adults. And healthcare providers and coaches should take note. 


Wednesday, July 27, 2022

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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