From Programs to Policy and Back Again: The Push and Pull of Realizing Type 2 Diabetes Prevention on a National Scale

Estimates for reach and population-level effectiveness of the National DPP under status quo and with alignment of health sector policies to increase identification and participation. *From the CDC report (2013) that 11.1% of U.S. adults with prediabetes are aware that they have it (3); by contrast, 62% of adults report having been tested for (and are aware of having) high LDL cholesterol (25,26). †There are no population estimates of the “linkage rate” to National DPP for screen-detected adults with prediabetes; by contrast, linkage to high-intensity treatment for abnormal blood cholesterol is about 70% of identified high-risk patients (25,26). ‡Current National DPP enrollment to date estimated from program growth as provided by Ely et al. (5); prior community effectiveness trials have demonstrated participation by 30–50% of adults referred to community DPP interventions after being made aware that they have prediabetes (6). §See text for details; assumes 18.4% of adults with prediabetes identified by HbA_1c will have type 2 diabetes in 10 years (17), 5% weight loss via the National DPP is associated with a 58% reduction in the development of type 2 diabetes (18), and 35% of National DPP participants reach ≥5% weight loss (5).