Effect on Health Care Expenditures During Nationwide Implementation of the Diabetes Prevention Program as a Health Insurance Benefit

Background Type 2 diabetes mellitus (T2DM) is an international problem of alarming epidemic proportions. T2DM can develop due to multiple factors, and it usually begins with prediabetes. Fortunately, this disease can be prevented by following a healthy lifestyle. However, many health care systems fail to properly educate the public on disease prevention and to offer support in embracing behavioral interventions to prevent diabetes. SMS messaging has been combined with cost-effective ways to reach out to the population at risk for medical comorbidities. To our knowledge, the use of nationwide SMS messaging in the Middle East as a screening tool to identify individuals who might be at risk of developing T2DM has not been reported in the literature. Objective The primary aim of this study was to assess the feasibility of conducting a series of SMS messaging campaigns directed at random smartphone users in Kuwait for the detection and prevention of T2DM. It was predicted that 1% of those receiving the text message would find it relevant and participate in the study. The secondary aim of this study was to assess the incidence of participation of those who were forwarded the initial text message by family members and friends. Methods In this study, 5 separate text message screening campaigns were launched inviting recipients to answer 6 questions to determine the risk of developing T2DM. If subjects agreed to participate, a link to the prediabetes screening test devised by the Centers for Disease Control and Prevention was automatically transmitted to their mobile devices. Those identified as high risk were invited to participate in a diabetes prevention program. Results A total of 180,000 SMSs were sent to approximately 6% of the adult population in Kuwait. Of these, 0.14% (260/180,000) of the individuals who received the SMS agreed to participate, of whom 58.8% (153/260) completed the screening. Surprisingly, additional surveys were completed by 367 individuals who were invited via circulated SMS messages forwarded by family members and friends. Altogether, 23.3% (121/520) qualified and agreed to participate in a diabetes prevention program. The majority of those who chose to participate in the prevention program were overweight, aged 45-65 years, and reported being less physically active than those who chose not to participate (χ22=42.1, P<.001). Conclusions Although health care screening via text messaging was found to have limited effectiveness by itself, it exhibited increased reach through shared second-party social media messaging. Despite the fact a subpopulation at possible risk of developing T2DM could be reached via text messaging, most responders were informed about the screening campaign by family and friends. Future research should be designed to tap into the benefits of social media use in health risk campaigns.

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Cost Savings and Reduced Health Care Utilization Associated with Participation in a Digital Diabetes Prevention Program in an Adult Workforce Population

Journal of Health Economics and Outcomes Research ◽

10.36469/jheor.2020.14529 ◽

2020 ◽

Vol 7 (2) ◽

Author(s):

Cynthia Castro Sweet ◽

Carolyn Bradner Jasik ◽

Amy Diebold ◽

Ashley DuPuis ◽

Bryan Jendretzke

Keyword(s):

Health Care ◽

Prevention Program ◽

Diabetes Prevention ◽

Claims Data ◽

Hospital Admissions ◽

Statistical Significance ◽

Cost Savings ◽

Diabetes Prevention Program ◽

Program Delivery ◽

The Impact

Background: Though in-person delivery of the Diabetes Prevention Program (DPP) has demonstrated medical cost savings, the economic impact of digital programs is not as well understood. Objective: This study examines the impact of a digital DPP program on reducing all-cause health care costs and utilization among 2027 adult participants at 12 months. Methods: A longitudinal, observational analysis of health care claims data was conducted on a workforce population who participated in a digital diabetes prevention program. Differences in utilization and costs from the year prior to program delivery through 1 year after enrollment were calculated using medical claims data for digital DPP participants compared to a propensity matched cohort in a differences-in-differences model. Results: At 1 year, the digital DPP population had a reduction in all-cause health care spend of US$1169 per participant relative to the comparison group (P = 0.01), with US$699 of that savings coming from reduced inpatient spend (P = 0.001). Cost savings were driven by fewer hospital admissions and shorter length of stay (P < 0.001). No other significant results in cost differences were detected. There was a trend toward savings extending into the second year, but the savings did not reach statistical significance. Conclusions: These results demonstrated significant short-term health care cost savings at 1 year associated with digital DPP program delivery.

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Health Care Providers’ Knowledge, Attitudes, and Practices and the Association With Referrals to the National Diabetes Prevention Program Lifestyle Change Program

American Journal of Health Promotion ◽

10.1177/08901171211044937 ◽

2021 ◽

pp. 089011712110449

Author(s):

LaShonda R. Hulbert ◽

Xuanping Zhang ◽

Boon Peng Ng ◽

Kunthea Nhim ◽

Tamkeen Khan ◽

...

Keyword(s):

Health Care ◽

Health Care Providers ◽

Prevention Program ◽

Diabetes Prevention ◽

Diabetes Prevention Program ◽

Marginal Effect ◽

Care Providers ◽

Attitudes And Practices ◽

Electronic Health ◽

Knowledge Attitudes And Practices

Purpose To examine how health care providers’ knowledge, attitudes, and practices affect their referrals to the National Diabetes Prevention Program. Design Cross-sectional, self-report data from DocStyles—a web-based survey Setting USA Sample Practicing family practitioners, nurse practitioners, pharmacists, and internists, n = 1,503. Measures Questions regarding health care providers’ knowledge, attitudes, and practices and their referrals to the National Diabetes Prevention Program. Analysis Bivariate and multivariate analyses were used to calculate predictive margins and the average marginal effect. Results Overall, 15.2% of health care providers ( n = 1,503) reported making a referral to the National Diabetes Prevention Program. Health care providers were more likely to make referrals if they were familiar with the program (average marginal effect = 36.0%, 95% CI: 29.1%, 42.8%), reported knowledge of its availability (average marginal effect=49.1%, 95% CI: 40.2%, 57.9%), believed it was important to make referrals to the program (average marginal effect = 20.7%, 95% CI: 14.4%, 27.0%), and used electronic health records to manage patients with prediabetes (average marginal effect = 9.1%, 95% CI: 5.4%, 12.7%). Health care providers’ demographic characteristics had little to no association with making referrals. Conclusion Making referrals to the National Diabetes Prevention Program was associated with health care providers’ knowledge of the program and its reported availability, their attitudes, and their use of the electronic health record system to manage patients with prediabetes.

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Presessions to the National Diabetes Prevention Program May be a Promising Strategy to Improve Attendance and Weight Loss Outcomes

American Journal of Health Promotion ◽

10.1177/0890117118786195 ◽

2018 ◽

Vol 33 (2) ◽

pp. 289-292 ◽

Cited By ~ 6

Author(s):

Natalie D. Ritchie ◽

Peter G. Kaufmann ◽

R. Mark Gritz ◽

Katherine A. Sauder ◽

Jodi Summers Holtrop

Keyword(s):

Health Care ◽

Weight Loss ◽

Health Care System ◽

Prevention Program ◽

Diabetes Prevention ◽

Diabetes Prevention Program ◽

Safety Net ◽

Analysis Of Covariance ◽

Weight Loss Outcomes ◽

Care System

Purpose: The National Diabetes Prevention Program (NDPP) is a widely disseminated lifestyle intervention. Attendance is problematic, leading to suboptimal weight loss, especially among racial/ethnic minority participants. We conducted a novel “presession” protocol to improve engagement of diverse NDPP candidates, comparing NDPP participants who attended a presession to those who did not on attendance and weight loss outcomes. Design: Longitudinal cohort study. Setting: A safety net health-care system. Participants: A total of 1140 patients with diabetes risks (58.9% Hispanic, 19.8% non-Hispanic black, 61.8% low income). Intervention: The NDPP has been delivered in a Denver, Colorado health-care system since 2013. The program included 22 to 25 sessions over 1 year. Beginning September 2016, individuals were required to attend a presession before enrollment that focused on (1) increasing risk awareness, (2) motivational interviewing to participate in the NDPP, and (3) problem-solving around engagement barriers. Measures: Duration and intensity of NDPP attendance and weight loss. Analysis: Outcomes of 75 presession participants who enrolled in the NDPP were compared to 1065 prior participants using analysis of covariance and multivariable logistic regression. Results: Presession participants stayed in the NDPP 99.8 days longer ( P < .001) and attended 14.3% more sessions ( P < .001) on average than those without a presession. Presession participants lost 2.0% more weight ( P < .001) and were 3.5 times more likely to achieve the 5% weight loss target ( P < .001). Conclusion: Presessions may improve NDPP outcomes for individuals from diverse backgrounds. A full-scale trial is needed to determine whether presessions reliably improve NDPP effectiveness.

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