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Time to Get Screened: Medicare Begins Covering Prevention of Type 2 Diabetes in April

Mar 26, 2018

Seniors Have Highest Success Rates in Prediabetes Programs

CHICAGO – Nearly half of Americans 65 and older have prediabetes, putting them at risk for heart disease, stroke and type 2 diabetes. Starting in April, millions of Medicare beneficiaries who meet criteria will have access to the Medicare Diabetes Prevention Program (MDPP), which will go a long way to helping prevent or delay the condition, notes the American Association of Diabetes Educators (AADE).

The MDPP is based on a model that has been proven to be effective by helping people prevent or delay type 2 diabetes through calorie reduction and becoming more active, and research shows seniors have the highest success rates. A relatively modest weight loss of 5 to 7 percent can have major health benefits including reducing the risk of developing type 2 diabetes. About 22 million Americans 65 and older could directly benefit from an MDPP, according to the Centers for Disease Control and Prevention (CDC).

“Ninety percent of people with prediabetes are unaware they have it and this new benefit provides a great incentive for everyone 65 or older to get screened by their healthcare providers,” said diabetes educator and AADE Spokesperson Kathleen Stanley, RD CDE, a program coordinator of diabetes education and prevention at Baptist Health, Lexington, Kentucky. “Those who fall within the prediabetes range on a diabetes screening should talk to their doctor about joining an MDPP, which can pay huge dividends. Seniors who have participated in these programs say it changed their lives.”

Eligible beneficiaries are those who:

  • Are enrolled in Medicare Part B
  • Have a body mass index (BMI) of at least 25, or at least 23 if self-identified as Asian
  • Meet one of the following three blood-check requirements within 12 months of the first core session: A1C value between 5.7 and 6.4 percent, or a fasting plasma glucose of 110 – 125 mg/dl or a 2-hour plasma glucose of 140-199 mg/dl
  • Have no previous diagnosis of type 1 or type 2 diabetes (other than gestational diabetes)
  • Do not have end-stage renal disease (ESRD)

Having prediabetes means blood sugar levels are higher than normal, but not high enough to be diagnosed with diabetes. Losing weight and increasing activity helps prevent or delay type 2 diabetes.

Medicare joins many insurance companies and self-insured employers in covering certain CDC-recognized diabetes prevention programs. Studies have shown that participation in these programs reduce the risk of developing type 2 diabetes by 58 percent overall, and by 71 percent in those 60 and older. People with diabetes spend more than twice as much on healthcare as those without diabetes due to longer hospital stays, unnecessary hospital readmissions, emergency room visits, and other chronic conditions such as heart disease, that result from diabetes. People with diagnosed diabetes incur average medical expenditures of about $13,700 per year, of which about $7,900 is attributed to diabetes. The total economic cost of diabetes is $345 billion a year, with Medicare and other government insurance paying more than 60 percent of that cost, so preventing or delaying the disease is significant.  

In 2012, the CDC funded six national organizations – including the AADE – to expand and sustain the National Diabetes Prevention Program. Now in-person classes are available nationwide. To become a CDC recognized diabetes prevention program, a program must show its participants lose 5 percent of their weight within the yearlong program and sustain the weight loss. The AADE DPP programs exceeded that goal – participants lost 5.63 percent of their weight on average.

CDC-recognized diabetes prevention programs are year-long programs led by lifestyle coaches who help those with an indication of prediabetes learn new skills and provide information, guidance, and accountability to help participants make healthy lifestyle choices and achieve and sustain their weight loss and physical activity goals. Programs are delivered in a group setting, so participants can share ideas, celebrate successes and work to overcome obstacles.

Diabetes educators are particularly well-suited to lead these programs because of their training and expertise in helping people learn how to manage diabetes. Many of the same techniques used in AADE diabetes self-management education and support (DSMES) programs for people already diagnosed with diabetes – such as meal planning to enhance weight loss, finding simple ways to be more active and employing methods to cope with stress – apply to preventing type 2 diabetes through CDC-recognized diabetes prevention programs.

“For people with prediabetes, participation in a diabetes prevention program can help prevent or delay the development of type 2 diabetes,” Stanley said. “For people already diagnosed with diabetes, participation in a DSMES program can help individuals achieve health goals.  Fortunately, now both programs are covered by Medicare.”

About AADE: 

AADE is a multi-disciplinary professional membership organization dedicated to improving diabetes care through innovative education, management and support. With more than 14,000 professional members including nurses, dietitians, pharmacists, exercise specialists, and others, AADE has a vast network of practitioners working with people who have, are affected by or are at risk for diabetes. Learn more at www.diabeteseducator.org, or visit us on Facebook (American Association of Diabetes Educators), Twitter (@AADEdiabetes) and Instagram (@AADEdiabetes).

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