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Medicare Diabetes Prevention Program: An Overview

Healthcare spending in the United States is approximately $3.3 trillion or $10,348 per person annually — and continues to grow. Each year, Medicare spends more than $104 billion treating patients with diabetes.

According to the American Diabetes Association, an estimated 25 percent of Medicare-eligible seniors have diabetes, and the prevalence of prediabetes is especially high in this age group. The Centers for Medicare & Medicaid Services (CMS) estimates that it spent approximately $1,500 more on Part D prescription drugs, $3,100 more for hospital and facility services and $2,700 more in physician and other clinical services for those with diabetes than those without it.

The good news for this population is that the most common type of diabetes, Type 2, often can be prevented or at least delayed through lifestyle and health changes.

Diabetes Prevention for Enrollees

Based on this conclusion, the Medicare Diabetes Prevention Program (MDPP) is designed to impede the onset of Type 2 diabetes for Medicare customers who:

  • Are enrolled in Medicare Part B
  • Have a body mass index (BMI) of at least 25 (at least 23 if self-identified as Asian)
  • Meet one of the following three blood test requirements within 12 months of the first core session:
    • A hemoglobin A1c test with a value between 5.7 and 6.4 percent
    • A fasting plasma glucose of 110-125 mg/dL
    • A 2-hour plasma glucose of 140-199 mg/dL (oral glucose tolerance test)
  • Have no previous diagnosis of type 1 or type 2 diabetes (other than gestational diabetes)
  • Do not have end-stage renal disease (ESRD)

The MDPP is available to eligible seniors and requires no referral or copayment. It is offered at more than 1,000 CDC-recognized organizations, including hospitals, community centers, YMCAs and more, in all 50 states, the District of Columbia, Puerto Rico and the U.S. Virgin Islands. However, the services that comprise it must be provided by Medicare-approved suppliers of the program.

Medicare Diabetes Prevention Program Curriculum

Updated in April of this year, the MDPP consists of a minimum of 16 intensive core sessions of a curriculum approved by the Centers for Disease Control and Prevention (CDC). Held over a six-month period, these sessions enable participants to receive group-based coaching and training focused on utilizing physical activity, dietary changes, behavior modification, stress management and weight loss strategies. They allow for group participation, accountability and direct interaction between coaches—including nutritionists and dieticians—and participants.

Once they complete the first 16 sessions, participants are invited to attend monthly follow-up meetings to help them maintain the healthy behaviors they learned. Participants who meet the program goal of a 5 percent weight loss may attend an additional year of ongoing maintenance sessions.

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