From Programs to Policy and Back Again: The Push and Pull of Realizing Type 2 Diabetes Prevention on a National Scale

The U.S. Centers for Disease Control and Prevention (CDC) estimates that about 1.9 million Americans develop diabetes yearly; most of them have type 2 diabetes, and almost one-third remain undiagnosed for several years (1). The Diabetes Prevention Program (DPP) provided strong evidence that lifestyle behavioral counseling interventions can prevent or delay about half of these new cases (2). Unfortunately, 15 years after the DPP, most people at high risk for developing diabetes have not been offered such an intervention (3). This gap separates millions of high-risk Americans from the most evidence-based solution currently known to prevent type 2 diabetes. In 2010, Congress authorized the CDC to launch the National Diabetes Prevention Program (National DPP), which supports organizational and workforce development, quality monitoring, and evaluation of efforts to scale up delivery of DPP-like lifestyle intervention programs nationally (4). As of April 2017, the National DPP registry listed 1,379 organizations offering DPP-like interventions across all 50 states, including 47 online-only programs and 1,332 organizations delivering face-to-face interventions (4). These numbers underscore the incredible growth in our nation’s capacity to provide DPP-like interventions. In this issue of Diabetes Care , Ely et al. (5) report findings of an evaluation of the first 14,747 adults who completed ≥1 National DPP visits through one of 220 registered organizations between February 2012 and January 2015. Strengths of this evaluation include the large sample size and inclusion of data for all National DPP participants; limitations include lack of a control group and no information about weight changes or other outcomes for participants who stopped attending the program. Still, this evaluation offers an important first glimpse of the success of National DPP’s scale-up since 2010. Over a 12-month period after their first visit, National DPP participants completed a median of 14 of 22 possible lessons and about half …