Wednesday, August 30, 2023

The Diabetes Prevention Program May be Helpful in Treating Non-alcoholic Fatty Liver Disease

An investigation to see if lifestyle modifications may stave off type 2 diabetes was spearheaded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The Diabetes Prevention Program (DPP) was the name of the study. The DPP study enabled participants with prediabetes to reduce their risk of type 2 diabetes by 58% compared to usual care. And the outcomes were achieved with only a little amount of weight reduction, good diet, and regular exercise. The study is viewed as a landmark study because of the outstanding results. And researchers in a recent study employed a modified version of the DPP to treat non‐alcoholic fatty liver disease (NAFLD).

Fat deposits in the liver are a symptom of non-alcoholic fatty liver disease (NAFLD). NAFLD includes nonalcoholic steatohepatitis (NASH) and non-alcoholic fatty liver (NAFL). If a person has NASH, the person also has liver fat and liver damage in addition to inflammation.

The NIDDK initiated the Diabetes Prevention Program (DPP) study in 1996 to see if weight reduction encouraged by good diet and exercise might be used to prevent type 2 diabetes in people with prediabetes. Three groups were included in the investigation, which was a randomized experiment. One group was treated for prediabetes with diet, exercise, and lifestyle changes; another utilized metformin as the treatment; and a third group received a placebo (representing usual care). 

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.

Based on positive results from the original DPP study, the CDC created the National Diabetes Prevention Program (National DPP). And a modified version of the National DPP, with some focus on NAFLD, was used in the study to treat the disease.

As a result of the utilization of modified National DPP, patients experienced weight loss, and improvements in liver-related parameters. BMI, hepatic steatosis, and HDL all showed significant improvements from baseline.

Wednesday, August 23, 2023

CMS Wants to Change the Medicare Diabetes Prevention Program for the Better

The Medicare Diabetes Prevention Program (MDPP) is an example of evidence-based LM methods being used to prevent and delay type 2 diabetes. And CMS is proposing to make the MDPP a lot easier to navigate, more flexible, and more effective. After receiving much criticism concerning the MDPP, and after gaining experience during the COVID-19 PHE, CMS wants to make the MDPP coincide more with the National Diabetes Prevention Program (National DPP).

And if organizations, providing 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).

If the proposed rules are put in place, CMS will allow DPP virtual delivery, and the pay structure will be fee-based and value-based. The number of G-codes will be reduced from 15 to 6. There will be one G-code for in-person attendance, and one G-code for virtual attendance.

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

There could be 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 will likely modify 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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