Approximately 30 percent of the three million people in metro Birmingham have pre-diabetes, a condition that can progress to Type 2 diabetes without treatment. The UAB Weight Loss Medicine Clinic is addressing this issue in Alabama by working with the Center for Disease Control (CDC) and the National Diabetes Prevention Program (DPP). The National DPP offers an evidence-based approach to treating prediabetes.

Acceptance in the CDC national program requires a one-year preliminary process to ensure the program is effective within the local site and the patient population. UAB Weight Loss Medicine Clinic was awarded a grant from the Alabama Department of Public Health, which assists the clinic to train additional lifestyle coaches within the clinic and to provide materials and salary support for a data manager.

"This national process is arduous. Essentially, we have one year to prove the effectiveness of our program," says Amy Warriner, MD, Medical Director for the UAB Weight Loss Medicine Clinic. "The CDC documentation requirements are rigorous, so we are collecting and analyzing data monthly and sending it to the CDC quarterly."

The DPP offers adults 18 and older, with a body mass index (BMI) greater than 24, an evidence-based program that can help prevent or delay the onset of type 2 diabetes through lifestyle changes. In addition to age and BMI requirements, those with pre-diabetes or who are at high risk for pre-diabetes are eligible as well as women with a history of gestational diabetes. Trained lifestyle coaches teach group classes with a strong emphasis on empowerment and prevention.

In the first year of this trial period, members of the UAB Weight Loss Clinic are working with patients who are at risk for diabetes. The program began in July 2019 and is led by Karen MacPherson Harrison, Registered Dietician and Certified Diabetes Educator, and Program Manager Kristy Corey.

Warriner says the DPP is one of the most well-studied, intensive lifestyle interventions that has ever been developed.

"All of the programs, regardless of where they are located, have shown similar success with intensive lifestyle interventions that have been superior to medications in reducing the progression of diabetes in people at risk," Warriner says. "It is a big task for the lifestyle coaches, because not only do they relay educational information to participants, they also motivate them to keep up with visits throughout the 12-month program. There is a correlation between the number of visits attended by participants and the health benefits. So we know that the more we can interact with them, the more likely they are to be successful in preventing diabetes and attaining moderate weight loss."

Harrison points out that the group dynamic also plays an important role in the success of the program.

"The CDC did studies on its specific curricula which is a blend of nutrition, activity and behavior," she says. "They found that a group dynamic is also a part of the success. The CDC wants the same people to come together weekly. When they do, it creates friendships and support that helps participants be successful. They are being accountable, not only to me as the facilitator, but also to each other. I've seen it happen, and it is amazing."

Warriner says that if they can demonstrate the effectiveness of their one-year trial, the UAB Weight Loss Medicine Clinic will be recognized as a fully accredited National Diabetes Prevention program site. At that point, the program would be eligible for insurance coverage. Medicare has already started covering the service. BlueCross BlueShield approved the diabetes prevention program code in January 2020, and she expects the other carriers to follow suit, making it easier for more people to take advantage of the program.

"Our goal is to continue the program, not only in our clinic but in other areas. The number of people in our community who are at risk for diabetes is overwhelmingly large, more than we can accommodate in our clinic itself. We need to find ways to broaden our ability to reach these patients with a goal of diabetes prevention," Warriner says. "I know that the success rates of preventing progression into diabetes are much better than the ability to reverse the disease once it is established. If we can intervene prior to the onset of diabetes, we have a 50 to 71 percent chance of preventing the disease."