Translating Knowledge into Action to Prevent Type 2 Diabetes: Medicare Expansion of the National Diabetes Prevention Program Lifestyle Intervention

Abstract

Policy Points Although preventable chronic conditions such as type 2 diabetes carry a significant cost and health burden, few lifestyle interventions have been scaled at a national policy level. The translation of the National Diabetes Prevention Program lifestyle intervention from research to a Medicare-covered service can serve as a model for national adoption of other interventions that have the potential to improve population health. The successful translation of the National Diabetes Prevention Program has depended on the collaboration of government agencies, academic researchers, community-based healthcare providers, payers, and other parties.

Context: Many evidence-based health interventions never achieve national implementation. This article analyzes factors that supported the translation and national implementation of a lifestyle change intervention to prevent or delay type 2 diabetes in individuals with prediabetes.

Methods: We used the Knowledge to Action framework, which was developed to map how science is translated into effective health programs, to examine how the evidence-based intervention from the 2002 Diabetes Prevention Program trial was translated into the Centers for Disease Control and Prevention's large-scale National Diabetes Prevention Program, eventually resulting in payment for the lifestyle intervention as a Medicare-covered service.

Findings: Key findings of our analysis include the importance of a collaboration among researchers, policymakers, and payers to encourage early adopters; development of evidence-based, national standards to support widespread adoption of the intervention; and use of public input from community organizations to scale the intervention to a national level.

Conclusions: This analysis offers timely lessons for other high-value, scalable interventions attempting to move beyond the evidence-gathering phase and into translation and institutionalization.

Keywords: Diabetes prevention; Medicare; translation.

Figure 1

The Knowledge to Action Framework^{a a}The Knowledge to Action framework was originally published by the Centers for Disease Control and Prevention Work Group on Translation.3 [Color figure can be viewed at http://wileyonlinelibrary.com]

Figure 2

The Knowledge to Action Framework for the National Diabetes Prevention Program^a Abbreviations: CDC, Centers for Disease Control and Prevention; CMS, Centers for Medicare and Medicaid Services; DPP, Diabetes Prevention Program; DPRP, Diabetes Prevention Recognition Program; Y‐USA, YMCA of the USA. ^aSee the Appendix for a detailed timeline and relevant references for the activities summarized in this diagram. [Color figure can be viewed at http://wileyonlinelibrary.com]