Frequently asked questions
We understand that developing a diabetes prevention strategy takes planning and that questions are bound to come up in the process. We invite you to browse our Frequently Asked Questions with sections organized by category.
DISCLAIMER: THE CONTENT ON AMApreventdiabetes.org (referred to as the “AMA Prevent Diabetes Website”) IS PROVIDED FOR INFORMATIONAL PURPOSES ONLY AND IS NOT INTENDED AS MEDICAL ADVICE, OR AS A SUBSTITUTE FOR THE MEDICAL ADVICE OF A PHYSICIAN. SOME CONTENT SUGGESTIONS AND BUDGET TOOLS MAY NOT BE RIGHT FOR YOUR PRACTICE OR PATIENTS, SO CONSULT YOUR LEGAL OR FINANCIAL ADVISER BEFORE DEPLOYING THEM.
What is the clinical evidence for a National DPP lifestyle change program?
The National DPP lifestyle change program is based on a 2002 research trial published in the New England Journal of Medicine that showed a 58% reduced incidence of type 2 diabetes in participants who went through a structured lifestyle intervention compared to those who received placebo treatment at an average follow-up of three years. Since this study, the program has been successfully translated into a variety of settings and patient populations and been adapted to be delivered through digital and distance learning modalities.
For more information about the evidence supporting the National DPP lifestyle change program, click here.
How do I locate a lifestyle change program in my area?
The national registry of recognized diabetes prevention programs lists contact information for all CDC-recognized organizations that deliver evidence-based type 2 diabetes prevention programs in communities across the United States. All of these programs have agreed to use a CDC-approved curriculum that meets the duration, intensity, and reporting requirements described in the DPRP standards. To find a program located near you, click here.
How is this different from other weight loss programs?
While weight loss is a goal of this program, the program is designed to help participants make sustainable healthy lifestyle changes to lower their risk of developing type 2 diabetes and improve their overall health.
How do you keep patients motivated to stay in the program for 12 months?
The CDC has developed a retention toolkit to assist with participant retention throughout the course of the 12 month program.
Lifestyle coaches for lifestyle change programs help motivate participants to stick with the program and reach their health goals. The CDC has a new web-based resource designed to be there for participants when the lifestyle coach can’t be. It will help participants keep their commitments and feel encouraged. Click here to be linked to the CDC's retention toolkit.
How do I deal with privacy/data screening info with lifestyle change program providers?
Many health care organizations require a data use agreement or a business associate agreement. Consult with your legal council or your compliance officer.
How do I use my electronic health record to help me identify and treat patients?
The AMA created a resource with suggestions and guidance on how to use your electronic health record (EHR) and technology to improve the care you provide patients with prediabetes. Click here for more information.
Does a patient need a referral to get into the National DPP lifestyle change program?
No, as outlined in CDC's 2018 DPRP Standards, the National DPP allows a maximum of 65% of a program's participants to be considered eligible without a blood test or history of GDM if they screen positive for prediabetes based on the CDC prediabetes screening test. The screening test can be found here.
A minimum of 35% of a program's participants must have had a recent (within the past year) blood test (may be self-reported) or claim code indicating they have prediabetes or history of GDM based on one of the following specifications: 1) Fasting glucose of 100 to 125 mg/dl; 2) plasma glucose measured 2 hours after a 75 gm glucose load of 140 to 199 mg/dl; 3) A1c of 5.7 to 6.4; 4) Clinically diagnosed GDM during a previous pregnancy (may be self reported).
Medicare participants can also self-referral but need to have a current blood test as outlined above to be eligible for coverage. The fasting glucose result for eligibility is 110-125 mg/dl.
Who from the health care organization or physician practice typically takes the lead on this work?
The AMA recommends creating a multidisciplinary project team comprised of team members who are involved in clinical practice, have continued support/buy-in from system leaders, are responsible for overseeing the planning and organizing of tasks to implement the initiative, and can navigate across the departments/business units within the health care organization. To learn more about the key considerations needed to create a diabetes prevention strategy, click here.
National DPP lifestyle change program offering
Can the AMA help me make a financial case for the National DPP lifestyle change program?
Yes. The AMA’s Diabetes Prevention Cost Savings Calculator allows health care organizations, payers and employers to customize anticipated enrollment and completion rates, based on their experiences with other programs, and looks at the potential immediately avoidable spend for those organizations that have high employee/member turnover.
How do we formalize a relationship with an external lifestyle change program?
There are a variety of key considerations to address when selecting an external National DPP lifestyle change program provider. This ranges from insurance coverage availability, program accessibility for your patient population, the program provider's ability/willingness to send participant data to the referring provider, etc.
In addition, to key considerations it will be important to consult your HIPAA compliance officer to determine if a BAA is needed to share referral information with the lifestyle change program provider. You should also create a data use/PHI sharing agreements with outside entities offering treatment outside the medical setting. We recommend you contact your compliance officer or legal department for direction.
To learn more about the key considerations needed to select and formalize a relationship with an external lifestyle change program, click here.
How do we decide to use an external lifestyle change program or create our own?
There are a variety of key considerations to address when making the decision to either refer into an external lifestyle change program or create a lifestyle change program for your health care organization to offer. These key considerations range from program alignment with your existing preventive health and population health offerings to cost and logistical items.
The AMA has worked with several health care organizations on deciding how to offer this program. To have free access to the AMA's best practices, and to learn more about the key considerations needed to make this decision, click here. You will be directed to complete an assessment which will populate a personalized guided process to create a diabetes prevention strategy.
What are the requirements to be a CDC-recognized program?
How many coaches do we need?
What is the skill set or recommended criteria to identify coach candidates?
CDC-recognized lifestyle change programs must have lifestyle coaches who are trained to use a CDC-approved curriculum and who have the knowledge and skills to effectively deliver the program. The minimum recommended length of training for new lifestyle coahces is at least 12 hours or two days. The lifestyle coach’s ability to support participants, provide guidance, and help groups work together effectively is essential for a successful lifestyle change program. A successful coach is able to energize the group and encourage lasting behavior changes. The CDC does not require certification or credentialing for Lifestyle Coaches and the coaches do not have to be licensed health care professionals. For more information about the CDC training requirements, click here.
How many classes do we offer at a time?
This is determined by your budget, the availability of coaches and the number of referrals received.
What is the maximum and minimum amount of participants needed in the lifestyle change program?
While there is no minimum number of participants required to hold a class, CDC recommends recognized organizations begin each cohort with 10-15 participants.
This is to allow for unforeseen circumstances that may result in a loss of participants. The 2018 DPRP Standards state that a CDC-recognized organization must have at least five eligible participants in each six-month data submission (this could include multiple individual class cohorts) who attended their first session at least 12 months but not more than 18 months before the submission due date, attended at least three core sessions in months one through six, and have had session dates that span at least nine months in order for the evaluation of their data to result in the achievement of preliminary or full recognition. Please review the 2018 DPRP Standards for further information, found here:
Can we offer the lifestyle change program to both employees and patients at the same time?
Can I have a mix of MDPP eligible and non-eligible covered patients in the same class?
Yes. Class participants can be 18 and older and include a mix of Medicare and non-Medicare eligible participants.
Is there an algorithm I can use to identify patients?
The AMA has developed Identification and Management protocols that use a step-wise approach to guide physicians and care teams in accurately identifying patients with prediabetes and managing them with an evidence-based treatment option. Click here for more information.
What continuing education resources are available from the AMA?
The AMA Ed Hub makes it easy for physicians to find, take, track and report education relevant to their needs and interests. Click here to be directed to continuing medical education activities on diabetes prevention and many other topics. Currently featuring JN Learning™ (CME from the JAMA Network™), STEPS Forward™ and other signature AMA education, the AMA Ed Hub provides meaningful education to improve care. If you are interested in additional activities click here.
What data about my lifestyle change program do I need to submit to the CDC?
To gain CDC recognition, your organization must show that it can meet the CDC standards and effectively deliver a proven diabetes prevention lifestyle change program. The CDC has created a video resource to assist with the process to submit evaluation data to the DPRP. To watch the CDC Technical Assistance video, click here.
For the list of standards, click here.
What other outcomes should I track?
You can consider measuring additional outcomes besides those required for CDC recognition. Examples include laboratory tests like the A1C or lipid panels, biometric data such as weight circumference and blood pressure or othe outcomes like patient satisfaction. Your project team can identify what additional outcomes you may want to track, the process for collecting and analyzing outcomes, and other key stakeholders you would need to involve to do this during the planning stages of your diabetes prevention strategy.
How do I know which patients have prediabetes?
There are three acceptable blood tests that can be used to diagnose prediabetes: the hemoglobin A1C, the fasting plasma glucose (FPG), and the 2-hour oral glucose tolerance test. The AMA has developed a prediabetes identification protocol that can be used by clinical care teams to determine which patients may need laboratory testing for prediabetes.
Are there quality measures?
There are no specific quality measures for prediabetes.
However, the AMA is working with the Physician Consortium for Performance Improvement to create screening, management and monitoring measures to be available in the summer of 2019. If you sign up for our clinical updates, you will be notified when the newly created measures are published.
What are the evidence-based treatments to help patients prevent type 2 diabetes?
The National DPP lifestyle change program is an evidence-based and effective intervention to prevent or delay new cases of type 2 diabetes. Other treatment options include medical nutrition therapy and metformin. The AMA has developed a management protocol for physicians and care teams to use in treating patients with prediabetes.
How do I receive payment for my Medicare patients that participate in the program?
For individual patients being seen by a clinician, prediabetes can be documented as part of the medical record using the appropriate diagnosis code. Clinicians can find a list of applicable diagnosis codes here. Clinicians will need to follow the billing and documentation requirements, including the use of CPT or HCPCS codes, specified by each payer.
Organizations who are delivering the National DPP lifestyle change program may also become a Medicare-approved MDPP supplier. Medicare and Medicare Advantage health plans will pay MDPP suppliers who are offering the program to Medicare beneficiaries.
Can I change the lifestyle change program curriculum?
Your organization must use an approved curriculum that meets the CDC requirements for recognition. You need to adhere to the core topics, but you are free to adapt with supplemental materials.
There are two approved curricula from the CDC- the Prevent T2 and the CDC DPP 2012 curriculum. Both are designed to promote behavior change and provide skills for life long changes.
To learn more about the National DPP lifestyle change program curriculum, click here.
Does this apply for pediatric patients as well?
The National DPP lifestyle change program is for participants 18 years of age and older.
Is there insurance coverage and reimbursement for the National DPP lifestyle change program?
Medicare reimburses Medicare Diabetes Prevention Program suppliers (requires preliminary or full recognition) who are offering the program and recognized by the CDC.
There are several private insurance companies covering the National DPP lifestyle change program as well as Medicaid coverage in selected states. Check here for a list of commercial plans and Medicaid that offers coverage for the diabetes prevention lifestyle change program.
How do I receive reimbursement from Medicare for delivering the program?
The first step to receiving reimbursement is to become a Medicare Diabetes Prevention Program (MDPP) supplier. To do this, you must first achieve preliminary or full recognition from the CDC which requires a data submission from a complete 12-month cohort. Once you achieve either preliminary or full recognition, you can then apply to become a MDPP supplier through Centers for Medicare and Medicaid Services (CMS). Once you are an approved MDPP supplier, you are able to receive reimbursement from Medicare. For more information on this process and the Medicare reimbursement requirements, click here.
What is the cost of the National DPP lifestyle change program for participants?
The cost for participating in the National DPP lifestyle change program depends on a variety of factors, including an individual's particular insurance coverage and benefits. Many public and private insurers offer the National DPP lifestyle change program as a covered benefit, as do many employers. It is not possible for the CDC or AMA to systematically collect this information at a national level, as payers are not required to report this information to either entity, and specific information on benefit and coverage packages is proprietary.
A host organization’s funding and resources and their ability to obtain payment via insurers or employers can help expand coverage in their local area. If the National DPP lifestyle change program is not yet covered through insurance or employer benefits, participants may pay out of pocket. A program provider or host organization can also partially or fully subsidize the cost to the participants through scholarships and sliding fee scales. The AMA has developed a budgeting resource to assist organizations in planning for costs.
The CDC has estimated the average cost of program delivery to be about $450 per participant annually, however the cost to participants will reflect the above factors. For more information, click here.
What infrastructure needs to be put into place for health care organizations/care teams to make referrals?
The AMA recommends patient identification and referral processes to be integrated into existing screening and referral processes.
To learn more about the key considerations needed to create a diabetes prevention strategy including a process for care team referrals, click here.
What information should I expect back from National DPP lifestyle change program providers?
The AMA recommends the lifestyle change program provider share the below patient progress feedback with the referring health care organization/practice:
(1) Confirmation that the patient enrolled or declined the program
(2) Notification that the patient dropped out of the program
(3) Notification of patient progress of key metrics like weight and physical activity at dedicated points throughout the program (such as session 4, 9 and 16)