National Diabetes Prevention Program (NDPP)

Delaware’s Action Plan

The Centers for Disease Control and Prevention (CDC) has invested significant resources in State Health Departments and other organizations to build momentum for a national movement to prevent type 2 diabetes based on sound scientific evidence. With support from the CDC and the National Association of Chronic Disease Directors (NACDD), the Delaware Health and Social Services’ (DHSS) Division of Public Health applied a partner engagement model for expansion of the National DPP in Delaware.

The Delaware virtual Diabetes Prevention State Engagement Meeting (vStEM) series – held on March 3, 17, and 31, 2021 – was a central component of this model. This meeting brought together a diverse group of organizations from across the state to acknowledge current partners for their diabetes prevention efforts and to engage new partners. All participants learned about national efforts to promote the National DPP, and Delaware’s successful diabetes prevention efforts were prominently showcased. The meeting offered key partners an opportunity to provide input in the development of a partner-driven action plan to prevent type 2 diabetes through scaling and sustaining the National DPP in Delaware.

During the vStEM meeting series and action planning process, the partners shared their professional insights and recommendations to help create a tailored, collaborative blueprint to develop specific strategies to prevent or delay type 2 diabetes. Partners focused their efforts on the following pillars:

• Increase awareness of prediabetes
• Increase availability of the National DPP lifestyle change program
• Increase coverage of the National DPP lifestyle change program
• Increase screening, testing, and referral of people at risk for type 2 diabetes into the National DPP lifestyle change program

Diabetes Prevention Program Clinical Research

The Diabetes Prevention Program (DPP) was a major multicenter clinical research study aimed at discovering whether modest weight loss through dietary changes and increased physical activity or treatment with the oral diabetes drug metformin (Glucophage) could prevent or delay the onset of type 2 diabetes in study participants. At the beginning of the DPP, participants were all overweight and had blood glucose, also called blood sugar, levels higher than normal but not high enough for a diagnosis of diabetes—a condition called prediabetes.

The DPP found that participants who lost a modest amount of weight through dietary changes and increased physical activity sharply reduced their chances of developing diabetes. Taking metformin also reduced risk, although less dramatically. The DPP resolved its research questions earlier than projected and, following the recommendation of an external monitoring board, the study was halted a year early.

The researchers published their findings in the February 7, 2002, issue of the New England Journal of Medicine.

Type 2 Diabetes and Prediabetes

Type 2 diabetes is a disorder that affects the way the body uses digested food for growth and energy.

Normally, the food one eats is broken down into glucose, a form of sugar. The glucose then passes into the bloodstream, where it is used by the cells for growth and energy. For glucose to reach the cells,however, insulin must be present. Insulin is a hormone produced by the pancreas, a fist-sized gland behind the stomach.

Most people with type 2 diabetes have two problems: insulin resistance—a condition in which muscle,liver, and fat cells do not use insulin properly—and reduced insulin production by the pancreas. As a result, glucose builds up in the blood, overflows into the urine, and passes out of the body, never fulfilling its role as the body’s main source of fuel.

About 29 million people in the United States have diabetes. Of those, 11 million are diagnosed and 8 million are undiagnosed. Ninety to 95 percent of people with diabetes have type 2 diabetes. Diabetes Is the main cause of kidney failure, limb amputation, and new-onset blindness in American adults. People with diabetes are more likely than people without diabetes to develop and die from diseases of the heart and blood vessels, called cardiovascular disease. Adults with diabetes have heart disease death rates about two to four times higher than adults without diabetes, and the risk for stroke is two to four times higher among people with diabetes.

Prediabetes is a condition in which blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. Prediabetes is also called impaired glucose tolerance (IGT) or impaired fasting glucose (IFG), depending on the test used to measure blood glucose levels. Having prediabetes puts one at higher risk for developing type 2 diabetes. People with prediabetes are also at increased risk for developing cardiovascular disease.

Prediabetes is becoming more common in the United States. The U.S. Department of Health and Human Services estimates that about one in four U.S. adults aged 20 years or older—or 57 million people—had prediabetes in 2007. Those with prediabetes are likely to develop type 2 diabetes within 10 years, unless they take steps to prevent or delay diabetes.

Disparities in prediabetes and diabetes in Delaware

DPP Results

The DPP’s results indicate that millions of high-risk people can delay or avoid developing type 2 diabetes by losing weight through regular physical activity and a diet low in fat and calories. Weight loss and physical activity lower the risk of diabetes by improving the body’s ability to use insulin and process glucose. The DPP also suggests that metformin can help delay the onset of diabetes.

Participants in the lifestyle intervention group-those receiving intensive individual counseling and motivational support on effective diet, exercise, and behavior modification-reduced their risk of developing diabetes by 58 percent. This finding was true across all participating ethnic groups and for both men and women. Lifestyle changes worked particularly well for participants aged 60 and older, reducing their risk by 71 percent. About 5 percent of the lifestyle intervention group developed diabetes each year during the study period, compared with 11 percent of those in the placebo group.

Participants taking metformin reduced their risk of developing diabetes by 31 percent. Metformin was effective for both men and women, but it was least effective in people aged 45 and older. Metformin was most effective in people 25 to 44 years old and in those with a body mass index of 35 or higher, meaning they were at least 60 pounds overweight. About 7.8 percent of the metformin group developed diabetes each year during the study, compared with 11 percent of the group receiving the placebo.

Points to Remember

The DPP showed that people at risk for developing diabetes can prevent or delay the onset of diabetes by losing a modest amount of weight through diet and exercise. DPP participants in the lifestyle intervention group reduced their risk of developing diabetes by 58 percent during the study.

DPP participants who took the oral diabetes medication metformin also reduced their risk of developing diabetes, but not as much as those in the lifestyle intervention group. The DPP’s impact continues as new research builds on the study’s results to find the best ways to delay, prevent, and treat diabetes.

Hope through Research

The DPP contributed to a better understanding of how diabetes develops in people at risk and how they can prevent or delay the development of diabetes by making behavioral changes leading to weight loss.

These findings are reflected in recommendations from the American Diabetes Association for the prevention or delay of type 2 diabetes, which stress the importance of lifestyle changes and weight loss.
The DPP’s impact continues as new research, building on the study’s results, seeks the most effective ways to prevent, delay, or even reverse diabetes.

DPP researchers continue to examine the roles of lifestyle and metformin and other diabetes medications in preventing type 2 diabetes. They also continue to monitor participants to learn more about the study’s long-term effects through the Diabetes Prevention Program Outcomes Study (DPPOS), a follow-up to the DPP. DPPOS is examining the impact of long-term risk reduction on diabetes-related health problems,such as nerve damage and heart, kidney, and eye disease.

The National Institute of Diabetes and Digestive and Kidney Diseases supports a wide range of research related to the DPP, such as studies that assess cost-effective methods of delivering lifestyle modifications in group settings and over the Internet, as well as methods to sustain behavior change and weight loss.

Other researchers are testing interventions similar to those used in the DPP to help prevent the development of or treat existing type 2 diabetes in children and youth.

Participants in clinical trials can play a more active role in their own health care, gain access to new research treatments before they are widely available, and help others by contributing to medical research.

For information about current studies, visit www.ClinicalTrials.gov

• National Diabetes Prevention Program Info Graphic
• YMCA ‘s Diabetes Prevention Program