Prevent diabetes to save money — and lives
CDC’s work-based program better than meds
A workplace wellness program isn’t just a feel-good benefit for employees. It could reduce the number of employees with Type 2 diabetes and save your hospital tens of thousands of dollars.
In fact, addressing diabetes at the workplace has become a major public health goal. The Centers for Disease Control and Prevention has created a year-long lifestyle change program that is now in use in more than a dozen hospitals and health systems across the country.
"Right now, one out of every ten people has diabetes. If current trends continue, one out of three people by 2050 would have diabetes, which is very frightening," says Kristina Ernst, RN, CDE, program consultant with CDC’s National Diabetes Prevention Program. "We really hope to make a dent in that and prevent a lot of people from developing Type 2 diabetes."
The high cost of chronic diseases prompted Tampa (FL) General Hospital to partner with CDC and a health insurer to ramp up efforts to prevent diabetes. A closer look at medical claims and health screening results revealed the impact of diabetes, says JoAnn Shea, ARNP, director of Employee Health Services.
"Our diabetic population goes up every year," says Shea. "We pay $6,000 more on average for a member with diabetes than someone without [the disease]."
Next year, 68 of the hospital’s 6,600 employees are likely to develop diabetes, according to an actuarial analysis by the United Healthcare, the hospital’s health insurance administrator. That means about $400,000 in new costs for the self-insured hospital.
There are other costs of undiagnosed and untreated diabetes, too. "The poor compliance [with recommended treatment] affects employees’ productivity and their ability to get to work," says Shea.
The problem is widespread. One in three Americans has pre-diabetes, the Centers for Disease Control and Prevention estimates. Almost 2 million were newly diagnosed in 2010, which is the most recent data available. And about one-fourth of people with diabetes remain undiagnosed.1
CDC says its lifestyle management program costs about $475 per participant, including marketing, overhead and a trained lifestyle coach. By comparison, a self-management class for newly diagnosed diabetics to help them learn how to handle their illness costs at least double that, says Debra Torres, MPH, associate director of Diabetes Prevention at CDC’s Division of Diabetes Translation.
Losing a few pounds makes a difference
Even modest lifestyle changes can have a dramatic effect on diabetes risk. That was the finding of the Diabetes Prevention Program trial2and it’s the basis for CDC’s National Diabetes Prevention Program, which provides year-long support as participants increase physical activity and improve their food choices.
The clinical trial involved 3,234 participants at 27 centers around the country. Those who lost weight and boosted their physical activity were 58% less likely to develop diabetes — a better outcome even than those who received the anti-diabetic drug metaformin.
As in the study protocol, CDC’s program calls for 150 minutes a week of physical activity, such as walking, and weight loss of just 5% to 7% of body weight. A 200-pound person would need to lose 10 to 14 pounds.
The CDC program emphasizes group support. Participants meet weekly for 16 weeks, then monthly for another six months.
"It’s a group discussion that’s facilitated by a lifestyle coach," says Ernst. "She encourages the class participants to talk about their struggles with weight loss and making changes, and to identify their own solutions. Oftentimes when you come up with your own solutions, you have a greater likelihood of success in making lifestyle changes."
Much of the focus is on maintaining weight loss a well-recognized problem and developing healthier eating habits. "There’s a lot of emphasis placed on ways to prevent relapse," says Ernst.
Yet even if participants eventually regain some of the weight, they still have a lower risk of developing Type 2 diabetes than those who didn’t make lifestyle changes, she says. There appears to be a lasting improvement in the body’s ability to use insulin, she says.
Targeting the pre-diabetic
At Tampa General, an incentive program encourages employees to participate in an annual health screening, which is a part of the employee health visit at their annual performance review. By participating, employees can earn discounts of up to $260 a year off their insurance premiums. About 95% of employees undergo the health screens, which include a blood test, Shea says.
Every employee receives an A1C test, a measure of blood glucose. "We found out that 28% of our employees are pre-diabetic," she says.
The hospital is training some staff members to become lifestyle coaches in the CDC program, which would be offered to both employees and the community, she says.
Even heightened awareness that comes from screening and education has an impact, she says. "We’ve already noticed people are moving toward better health choices," Shea says.
Organizations around the country are beginning to promote and offer the CDC diabetes prevention program, including the Black Women’s Health Initiative, the YMCA, and the American Association of Diabetes Educators.
CDC is working with the Center for Medicare & Medicaid Services (CMS) as well as private insurers to provide the diabetes prevention program as a covered benefit. "The way to really get this program in the hands of most of the population is through the workforce — through employers and insurers," says Torres.
Employers also can play a role in supporting diabetics to maintain their health. At Tampa General, starting in 2014, employees diagnosed with diabetes can earn up to $300 on a Health Reimbursement Account card by participating in approved activities such as attending a diabetes education class, meeting with a pharmacist to review medications or a nutritionist to review diet, participating in a weight-loss program, or getting quarterly A1C testing. The employees can use the HRA card towards their medical and prescription deductibles in 2015, including test strips and lancets.
"We have quite a few diabetic employees who struggle to pay their co-pays for their medications and may not fill their prescriptions or purchase test strips and lancets to regularly test their blood sugar," says Shea. "We hope this program assists our diabetic employees with managing their diabetes better to avoid complications in the future."
[Editor’s note: More information about the CDC National Diabetes Prevention Program is available at www.cdc.gov/diabetes/prevention/index.htm.]
- Centers for Disease Control and Prevention. 2011 National diabetes fact sheet. Available at www.cdc.gov/diabetes/pubs/estimates11.htm.
- Orchard TJ, Temprosa M, Goldberg R, et al. The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: The Diabetes Prevention Program randomized trial. Ann Intern Med 2005; 142:611-619.