Future plans include a telehealth option contracted with rural sites, the addition of four additional new physical sites, and a possible demonstration project with the state Medicaid program.
A major question has been whether the intensive lifestyle intervention provided in the optimal DPP clinical trial setting could be implemented in the real world. At the meeting, Ms. Butcher and Mr. Vanderwood described how the adapted version of the DPP lifestyle intervention was delivered in the state of Montana via group sessions conducted within established diabetes education programs. They also offered advice on how other parts of the country might follow suit.
Diabetes educators were key. “Diabetes educators are uniquely qualified and uniquely situated to provide diabetes prevention,” said Ms. Butcher, quality diabetes education initiative coordinator with the Montana Department of Public Health and Human Services in Helena.
“Here in Montana we’re providing the evidence that is needed for reimbursement for diabetes educators doing prevention,” she added, referring to an issue that was raised numerous times throughout the AADE meeting.
Mr. Vanderwood, who served as the Montana project’s program manager but is now a PhD student in epidemiology at the University of Pittsburgh, said that the concept initially came from the state’s medical officer, who recognized the burden of diabetes in the state and the importance of prevention. In 2006, he urged the state health department to request available tobacco settlement funding for chronic disease programs, including diabetes prevention.
A subsequent bill that provided funding for asthma, cancer, cardiovascular disease, and diabetes was signed into law in April 2007. The keys to securing funding were the strong evidence base of the DPP, the leadership within the health department, the fact that the proposed program had measurable objectives, and a supportive legislative subcommittee that “understood the importance of diabetes prevention,” Mr. Vanderwood said.
Seeking support through state legislation is one way to obtain funding. Other sources include existing wellness programs or having participants themselves pay. In addition, a new partnership between UnitedHealth Group and the Centers for Disease Control and Prevention is launching diabetes prevention programs that will be delivered to covered employees through Walgreen’s pharmacies and local YMCAs around the country. Hopefully that will spur coverage from other insurers, he commented.
In addition to diabetes prevention programs, other proven options might include work sites, churches, and YMCAs, Ms. Butcher said.
Both Ms. Butcher and Mr. Vanderwood stated that they had no financial disclosures.