We Can Prevent Diabetes Research Study

Delivering the National DPP to Medicaid Populations

The Minnesota Department of Health (MDH), in partnership with the Minnesota Department of Human Services (DHS), conducted a study to test the effects of incentives on attendance and weight loss among Medicaid recipients taking part in the Diabetes Prevention Program (DPP).  The Centers for Medicare and Medicaid Services (CMS) funded the study through a five-year, $10 million grant. The primary goals were to:

• See what effect financial incentives had on Medicaid participants’ weight loss and attendance
• Learn how to successfully recruit Medicaid participants in the DPP

The burden of diabetes in low-income populations

An estimated 37% of American adults have prediabetes, a condition where blood glucose levels are higher than normal, but not high enough to be considered diabetes. Without intervention, 15% - 30% will develop type 2 diabetes within five years.

When the study was conducted in 2014, 7.4% of Minnesota adults had diabetes.  Rates were higher if adults are older, overweight or obese, completed less education or have household incomes less than $35,000.¹

National DPP background

The DPP is a proven lifestyle change program that aims to prevent or delay the onset of type 2 diabetes. The program emphasizes healthy eating and physical activity with an end goal of 5% -7% weight loss among participants. MDH has been actively working on increasing access to the DPP since 2008.

Minnesota has seen better attendance and weight loss results through the DPP by addressing barriers such as literacy and language, in addition to socioeconomic barriers.

We provided tools such as scales and measuring cups, and offered materials in different languages. Additionally, we provided assistance around transportation and childcare, and provided incentives in the effort to maximize weight loss and attendance.

The study and its results

Through the study,² we enrolled 1,154 participants into 98 groups. Among the 847 attending at least one National DPP session:

• 71.2% were women
• The average age was 48.3 years old
• 79.3% were obese
• 87.6% entered the study with an elevated HbA1c or fasting plasma glucose
• They lost an average of 4.2 pounds
• They increased good cholesterol levels on average

Participants’ primary languages were:

• English (72.4%)
• Somali (21.0%)
• Hmong (3.1%)
• Spanish (2.2%)

We engaged health care systems and participants to help identify successful strategies for recruitment and how best to support DPP participants in making lifestyle changes. This included:

• An advisory council to guide and support the study
• Medicaid beneficiary focus groups
• Community Conversations for Diabetes Prevention and Care Action
• Monthly meetings with WCPD clinic staff
• End of study interviews and focus groups

Key lessons

• Many participants reported making healthier food choices and increasing their physical activity after participating in the National DPP.
• We identified successes and areas of opportunity for recruitment, sustaining participation and supporting patients’ success in making lifestyle changes.
• Involvement of a primary care provider is crucial – participants who had a provider referral were more likely to enroll and stay engaged.
• Clinic partnerships benefit everyone; in an effort to cut down on wait time to start a class, clinics referred participants to other clinics that had classes starting sooner or classes that were culturally appropriate.
• Cultural barriers still made recruitment and engagement difficult.
• In some communities, diabetes is not well understood and prevention is not part of routine medical care, so it was important to have tailored communication materials.

References

¹Minnesota Department of Health (2016). Income, employment and diabetes in Minnesota. 
²Desai J. et al.  Financial incentives for diabetes prevention in Medicaid population: Study design and baseline characteristics.  Contemp Clin Trials.2017 Feb;53:1-10.

³Gilmer T et. al. Cost-Effectiveness of a Community-Based Diabetes Prevention Program with Participation Incentives for Medicaid beneficiaries. Health Serv Res. 2018 May, e-published