The Diabetes Prevention Gap And Opportunities To Increase Participation In Effective Interventions

Abstract

To understand the current state of prediabetes burden and treatment in the US, we examined recent trends in prediabetes prevalence, testing, and access to preventive resources. We estimated 13.5 percent prevalence of diagnosed prediabetes in the overall US adult population, using national survey data. Although prediabetes prevalence increased by 4.8 percentage points from 2010 to 2020, access to preventive resources remained low. The most effective intervention for diabetes prevention, known as the National Diabetes Prevention Program, remained woefully undersupplied and underused. There are only 2,098 National Diabetes Prevention Program-recognized providers nationally, and only 3 percent of adults with prediabetes have participated in the program. We suggest three actions to augment prevention efforts: increase payment for prevention interventions to avoid supply distortions, improve data integration and patient follow-up, and extend coverage and broaden access for preventive interventions. These actions, which would require policy-level changes, could lower the barriers to prevention.

ExhiBit 2

Undiagnosed prediabetes in the US, by race, ethnicity, sex, and insurance status, 2016–17 SOURCE National Health Interview Survey. NOTES Undiagnosed prediabetes was defined as adults with an elevated American Diabetes Association risk score (>5) but with no self-reported diagnosis of prediabetes. Total mean values of this measure of undiagnosed prediabetes by insurance category are as follows: no insurance, 21.0%; Medicaid, 28.1%; Medicare, 62.7%; and private, 20.6%.

Exhibit 3

Referrals to and participation in diabetes prevention programs (DPPs) in the US, by sex and insurance status, 2016–17 SOURCE National Health Interview Survey. NOTES National Health Interview Survey questions pertaining to participation in and referral to type 42 diabetes prevention programs: Have you EVER participated in this type (DPP) of year-long program to prevent type 2 diabetes? Has a doctor or other health care professional ever referred you to such a program to prevent type 2 diabetes?