The DPRP allows for four delivery modes: In-person, Online, Distance Learning, and Combination. The online and distance learning modalities are playing an invaluable role in improving access to the National DPP. Currently, enrollment in online and distance learning programs is exceeding that of in-person programs.

Hello, Dr. Wallia-

Please know that this information was highlighted during the 2017 Office of Management and Budget Federal Register Notice public comment process where CDC placed our revised 2018 DPRP Standards on the Federal Register (found here originally: federalregister.gov/documents/...). CDC has since held multiple webinars on the key Standards changes.

Since this is a critical question, I'm happy to share the document that was placed on the Federal Register that highlights all key changes from the 2015 to the 2018 DPRP Standards. I have passed that document along to forum moderator who will be uploading it shortly. It's important to know that many of the revisions occurred to align with the Medicare Diabetes Prevention Program (MDPP) expanded model. Thank you.

Here is a link to the key changes from the 2015 to the 2018 DPRP Standards that Dr. Gruss highlighted above: files.ama-ihmi.org/image/authe...

A cadre of both in-person and virtual CDC-recognized organizations have been shown to be effective (i.e., met all the DPRP Standards and achieved full CDC recognition). And, more are achieving full CDC recognition routinely, such as Omada Health. With 84.1 million Americans having prediabetes, the National DPP effort cannot offer a 'one size fits all' modality. CDC is excited to have four modality options (i.e., in-person, online, distance learning like telehealth, and combination) to offer those persons in hard-to-reach geographic locations or those who prefer a varied program delivery mode. We feel, and have seen, that all can be effective and successful.

The current evidence such as data from Omada Health and the E-LITE clinical trial has demonstrated the effectiveness of digital DPPs in populations that are primarily non-Hispanic white with relatively high socioeconomic status. More studies/data should be conducted/collected to evaluate the effectiveness of digital DPPs in underserved populations, especially those live in remote, rural areas where alternative delivery approach of DPP might be in particularly high demand.

The CDC's DPRP is currently tracking outcomes on over 219,000 enrolled participants across four delivery modalities, half of whom are virtual participants across all geographic areas and all races/ethnicities. However, not until the current 2018 DPRP Standards has CDC collected evaluation data across low SES status. During the Office of Management and Budget Federal Registry Notice public comment period in 2017, CDC reported that we had received numerous anecdotal comments from organizations over the past few years that low SES populations are less likely to achieve 5% weight loss. The Education Level data element, as opposed to one that is more difficult to collect (e.g., income), will allow CDC to determine if there are disparities that could require future changes to the DPRP Standards.

At Solera Health we partner with organizations that provide DPP in all four modalities. I don't know if it is as effective to ask whether one modality is "better" than another than it is ask if populations are matched to the best possible modality given different capabilities, preferences, and access to resources. We need to ensure there are options for everyone at risk of developing diabetes, and especially to adapt education, resources and DPP programs to be responsive to communities experiencing health disparities.

It's great to know CDC is tracking outcomes across all geographic areas and all races/ethnicities for all four delivery modalities. In our previous work among American Indians and Alaska Natives (AI/ANs), we found in-person DPP did not work as well in those with low SES status, especially those with low income. And those SES disparities seem to be partially mediated by differences in making changes in their dietary behaviors (ncbi.nlm.nih.gov/pubmed/264948...). Also, in another study, we found participants from sites with lower neighborhood SES status, higher level of racial residential segregation, and lower level of vehicle occupancy benefited less from the in-person DPP (ncbi.nlm.nih.gov/pubmed/295349...). It will be intriguing to see whether digital DPPs would work better in those individuals/neighborhoods.

Dr. Jiang, thank you so much for sharing these studies and resources. I'm especially interested in learning about the specific factors made the in-person delivery difficult. Since Medicare DPP is required to be held in-person, it is critically important that we work together to overcome barriers to ensure good outcomes.

Hey Stephanie, I too want to add my thanks to the CDC for your hard work and for the DPRP standards. I am a not a scientist but very concerned with chronic ailments,like diabetes, and in particular the lack of patient adherence to prescribed medications. Certainly standards to better train and qualify "educators" on how to best help patients is needed. Do you have thoughts on how we can better educate patients directly so they develop a keener sense or responsibility toward their own health? Or is there a system or rewards for meeting prescribed outcome goals that you have seen with positive results? thank you, Terry

Thanks for your interest in our studies. We too feel it is important to identify factors related to the success of DPP delivery. For in-person DPP, based on our past experience, lack of transportation and low household income seem to be two main barriers for a participant to fully benefit from in-person DPP. And both of these factors imply that availability of affordable healthy food might be particularly important to ensure the success of the intervention...

Thank you Dr Jiang!

Hello, Josh. Please know that CDC used a specific body of evidence that was published along with our 2015 DPRP Standards during the Office of Management and Budget Federal Register Notice public comment period. Please e-mail me directly and I can forward you a copy of that document as I'm not sure how to attach it here. Thanks.

Here is the CDC's specific body of evidence that was published along with the 2015 DPRP Standards during the Office of Management and Budget Federal Register Notice public comment period: files.ama-ihmi.org/image/authe...

CDC-recognized diabetes prevention lifestyle change programs can help people prevent or delay type 2 diabetes and improve their overall health. In addition to the obvious health benefits, here are some other reasons to consider offering such a program:
• Studies have shown that people with prediabetes who take part in a structured lifestyle change program and lose 5% to 7% of their body weight through healthier eating and 150 minutes of physical activity per week can cut their risk of developing type 2 diabetes by 58% (71% for people over 60 years old).
• In addition, lifestyle change programs can reduce the risk of heart attack and stroke associated with prediabetes and improve participants’ overall health.
• CDC monitors and evaluates programs to ensure quality and provides feedback on data submitted so you can make improvements if needed. Because the CDC-recognized programs are so effective, some employers and insurers (like Medicare) are offering them as covered benefits.
• CDC lists all recognized lifestyle change programs on its website. When someone searches for a lifestyle change program in your area, your organization will be on the list. This can bring increased visibility to your organization and its programs.
• Additionally, the science behind the program and its association with CDC brings added credibility. People will know you’re offering a trusted program. This can help with enrolling participants and getting referrals from health care professionals.

Hi, Christopher! I'm not sure if you saw my response to Nathan. But, I would like to add that here and attempt to help answer your question as well.

My previous response was: In order to expand availability and increase program participation (especially for those in rural or remote locations), the CDC Diabetes Prevention Recognition Program (DPRP) Standards and Operating Procedures (Standards) were amended in January 2015 to allow on-line modes of delivery in addition to in-person diabetes prevention programs. The Standards were amended again in 2018 to include the addition of distance learning and combination delivery models as well as on-line. This inclusion was based on published translational research, feedback from stakeholder organizations, and an environmental scan, where CDC concluded that there was sufficient evidence to allow organizations delivering virtual lifestyle programs to apply for CDC recognition as part of the National Diabetes Prevention Program (National DPP). These virtual providers must deliver a CDC-approved curriculum that follows the evidence-base of the Standards and are held accountable to the same quality Standards as in-person deliverers. The DPRP began accepting applications from virtual program providers in February 2015. We now have 100's of on-line providers and many have achieved Full CDC recognition.

We certainly believe that all types of virtual programs are vital to reaching populations with geographic disparities and those who would otherwise not be inclined to participate in in-person programs. We agree with you that having alternate program delivery modalities is an important part of population health and in reaching the 84 million Americans with prediabetes.

CDC-recognized virtual organizations are held to the exact same set of evidence-based standards as in-person organizations. It means that they, too, are delivering, and being monitored and evaluated to deliver, a quality National DPP lifestyle change program with fidelity to diabetes prevention science.

Digital delivery has the potential to improve access, remove barriers to adoption, and increase equity. However, technology itself can be a barrier for some

A key part of CDC's National Diabetes Prevention Program (National DPP) is the lifestyle change program to prevent or delay type 2 diabetes. Thousands of lifestyle change programs nationwide teach participants to make lasting lifestyle changes, like eating healthier, adding physical activity into their daily routine, and improving coping skills.

To ensure high quality, CDC's Diabetes Prevention Recognition Program (DPRP) recognizes lifestyle change programs that meet certain evidence-based standards and show they can achieve results. These standards include following an approved curriculum, facilitation by a trained lifestyle coach, and submitting data every 6 months to show that the program is having an impact. Organizational data are submitted to the DPRP for quality review and those meeting the standards earn either preliminary or full CDC recognition. The DPRP also provides progress and evaluation reports, and technical assistance to help with this process.

To find out more about CDC-recognized lifestyle change programs to prevent or delay type 2 diabetes, visit cdc.gov/diabetes/prevention/pr....

As a physician, I really appreciate that the DPRP provides quality assurance for the various lifestyle change programs that are part of the National DPP. By referring to programs that are recognized by the CDC, I know that my patient will get the appropriate curriculum and solid coaching that will maximize their chances of achieving the 5% weight loss that we want to see in our patients with prediabetes.

Thank you for that comment, Dr. Kirley. We really appreciate our partnership with physicians like yourself!