Prevent Diabetes STATHannah Herold, MPH, MA, CHES

Chronic Disease Prevention ProgramWyoming Department of Health

Partnering with Wyoming Primary Care Association

Objectives

• Understand the prevalence and burden of type 2 diabetes in Wyoming.

• Review the Prevent Diabetes STAT toolkit developed by the American Medical Association and Centers for Disease Control and Prevention.

• Learn how to identify patients at risk for diabetes, refer them to an appropriate Diabetes Prevention Program (DPP), and increase enrollment and participation in DPPs.

• Identify resources available to health care professionals to help you Screen, Test, and Act Today!

Prevalence of Diabetes in Wyoming

Source: 2011-2015 Wyoming BRFSS, retrieved from https://health.wyo.gov/publichealth/prevention/chronicdisease/data/

Cost of Diabetes in Wyoming

Total Inpatient Costs:

$232,825,610

People with diabetes incur an average of

$7,900in medical costs per year.

WHAT IS THE NATIONAL DIABETES PREVENTION PROGRAM?

Polling Question

Have you ever heard of the National Diabetes Prevention Program?

NDPP Overview

• A lifestyle change program following an evidence-based, CDC-approved curriculum

• Designed for people who have prediabetes or are at risk for type 2 diabetes

• Consists of 16 weeks of intervention (Core Phase) followed by 6 months of maintenance and follow-up (Core Maintenance Phase)

• Focuses on healthy habits

Standard NDPP Curriculum

Core Phase (16 Weeks over 6 months)

Program Overview/Introduction Manage Stress

Get Active to Prevent T2 Find Time for Fitness

Track Your Activity Cope with Triggers

Eat Well to Prevent T2 Keep Your Heart Healthy

TrackYour Food Take Charge of Your Thoughts

Get More Active Get Support

Burn More Calories Than You Take In Eat Well Away from Home

Shop and Cook to Prevent T2 Stay Motivated to Prevent T2

Standard NDPP Curriculum

Core Maintenance Phase (6 Months)

When Weight Loss Stalls Get Back on Track

Take a Fitness Break Prevent T2 – For Life!

Stay Active to Prevent T2

Stay Active Away from Home

More About T2

More About Carbs

Have Healthy Food You Enjoy

Get Enough Sleep

NDPP Outcomes

NDPP is a result of a major clinical research study designed to test whether lifestyle changes (diet and physical activity) could prevent or delay onset of type 2 diabetes.

National Institute of Health (NIH)-funded3-arm Randomized Control Trial

Control

Group

Intervention

Group 1

Intervention

Group 2

Placebo MetforminIntensive Lifestyle

Coaching*

Outcome – 3 years

Intervention Group 2

A 5-7% body weight loss reduced the risk of developing type 2 diabetes by 58% in those with prediabetes (71% in those 60+ years).

Outcome – 10 years

Intervention Group 2

34% decrease in prevalence of type 2 diabetes.

*Individual counseling and motivational support on effective diet, exercise, and behavior modification

NDPP OutcomesReduction in Risk of Developing Type 2 Diabetes

11

7.8

4.8

0

2

4

6

8

10

12

Intensive lifestyle intervention (NDPP)

(n=1079)

T2D

M in

cid

en

ce

pe

r 1

00

pe

rso

n-y

ear

s

Placebo(n=1082)

Metformin850 mg BID

(n=1073)

58%

31%

NDPPs in WyomingFind NDPP Sites through the CDC NDPP Registry:

https://nccd.cdc.gov/DDT_DPRP/Registry.aspx

Find Online Programs:

https://nccd.cdc.gov/DDT_DPRP/Programs.aspx

Polling Question

Have you ever referred patients to a NDPP?

HOW CAN I HELP PREVENT DIABETES STAT?

Screen / Test / Act Today

Prevent Diabetes STAT

• A guide to refer your patients with prediabetes to an evidence-based diabetes prevention program

• Developed by the American Medical Association (AMA) and Centers for Disease Control and Prevention (CDC)

• Contains tools for healthcare providers to complete each of the three steps to Prevent Diabetes STAT:• Screen patients for prediabetes

• Test patients for prediabetes

• Act Today by referring patients with prediabetes to a Diabetes Prevention Program

• www.preventdiabetesstat.org

Overview of Tools

Overview of Tools

Chatbox Question

What information do you need to know about a community-based program before you consider

referring patients to it?

Engaging Clinicians

• Understand what a NDPP is and how a patient would benefit from it.• Use Clinician Fact Sheet

• Understand who is eligible for referral to a NDPP• *Prevent Diabetes STAT Toolkit has old eligibility guidelines

NDPP Eligibility

All participants MUST:

• Be 18+ years old

• Have a Body Mass Index (BMI) of ≥25 kg/m2 (≥23 kg/m2 , if Asian American)

All of a program’s participants must be considered eligible based on either:

• A recent (within the past year) blood test meeting one of these specifications:• Fasting glucose of 100 to 125 mg/dl• Plasma glucose measured 2 hours after a 75 gm glucose load of 140 to 199 mg/dl • A1c of 5.7 to 6.4 • Clinically diagnosed gestational diabetes mellitus (GDM)

• A positive screening for prediabetes based on the Prediabetes Screening Test

*Participants cannot have a previous diagnosis of type 1 or type 2 diabetes prior to enrollment

Engaging Patients

Engaging Patients

Engaging Patients

Prevent Diabetes STAT in your Practice

• Preventing Diabetes STAT is more than just posters and handouts – it requires engagement from the entire practice team.

• Create a MAP for screening, testing, and referring patients in your practice.

• MAP: Measure, Act, Partner.

• Use a MAP to determine roles and responsibilities for identifying patients at risk for diabetes and referring them to appropriate service.es

Polling Question

Does your practice have a standardized procedure for identifying patients at risk for diabetes and

referring them to appropriate resources?

MAP: Measure

Two ways to measure patients:

1. Point-of-Care Method

2. Retrospective Method

MAP: Act

Two ways to Act:

1. Point-of-Care Method

2. Retrospective Method

MAP: Partner

Two ways to partner:

1. With DPPs

2. With Patients

Point-of-Care MAP

Point-of-Care MAP

Point-of-Care MAP

Retrospective MAP

Retrospective MAP

Retrospective MAP

Polling Question

Which method of measuring are you more likely to use in your practice?

(Point-of-Care, Retrospective, or Both)

Activity – Developing a MAP

• Looking at the MAP provided by the Prevent Diabetes STAT Toolkit:

1. Identify whether your practice could use point-of-care measurement, retrospective measurement, or both to identify patients at-risk for diabetes.

2. Then, identify WHO is responsible for each of the selected tasks for both measuring and acting.

3. Next, note HOW your practice will complete the selected tasks – what tools will you use? What tools or information do you still need?

4. Finally, identify your partners.

5. Compile your MAP into a standardized procedure for your clinic.

Chatbox Question

What is the most challenging aspect of screening, testing, and referring patients at risk for diabetes?

WHY IS THIS IMPORTANT?

Importance of Preventing Diabetes STAT

• Value to patients• Improved health outcomes

• Reduced incidence and prevalence of diabetes

• Better patient satisfaction

• Improved quality of life

• Value to clinic• Patient-Centered Medical Homes require team-based care, care coordination, evidence-

based clinical decision support, etc.

• Increased income

• Value to community• Healthier population and workforce

Other Helpful Resources

• Patient Letter/Email and Phone Script

• Standardized Referral Forms

• Cowboy Up to Prevent Diabetes Toolkit• Printed and bound Prevent Diabetes STAT Toolkit

• Laminated prediabetes risk tests

• Full-size prediabetes awareness posters

• To order, fax order form to 307-777-8604

Billing/Coding ResourcesCPT Code Description

99381-99387 Preventive Visit- New Patient- Commercial/Medicaid

99391-99397 Preventive Visit- Established Patient- Commercial/Medicaid

G0438 Annual Wellness Visit- Initial- Medicare

G0439 Annual Wellness Visit- Subsequent- Medicare

83036QW Office-based Hemoglobin A1C testing

82962 Office-based finger stick glucose testing

Billing/Coding ResourcesICD-10 Code Description

Z13.1 Encounter for screening for diabetes mellitus

R73.09 Other abnormal glucose

R73.01 Impaired fasting glucose

R73.02 Impaired glucose tolerance (oral)

R73.9 Hyperglycemia, unspecified

E66.01 Morbid obesity due to excess calories

E66.09 Other obesity due to excess calories

E66.8 Other obesity

E66.9 Obesity, unspecified

E66.3 Overweight

Z68.3x Body mass indexes 30.0-39.9 (adult)

Z68.4x Body mass indexes >= 40.0 (adult)

Chatbox Question

What does your practice need help with to best meet the needs of your patients at risk for

diabetes?

QUESTIONS?