Scaling the National Diabetes Prevention Program in Underserved Areas

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Approximately 86 million Americans, or 1 in 3 adults, have prediabetes. Prediabetes is a health condition characterized by blood glucose levels that are higher than normal but not high enough to be diagnosed as diabetes. People with prediabetes have an increased risk of developing type 2 diabetes, heart disease, and stroke. Prediabetes is treatable, but only about 10 percent of people who have it are aware that they do. The CDC-led National Diabetes Prevention Program (National DPP) is a partnership of public and private organizations working collectively to build the program delivery infrastructure for an evidence-based lifestyle change program for adults with prediabetes to prevent or delay onset of type 2 diabetes. The lifestyle change program is founded on the science of the 2002 NIH Diabetes Prevention Program research study, and several translation studies that followed, which showed that making modest behavior changes helped participants with prediabetes lose 5% to 7% of their body weight and reduce their risk of developing type 2 diabetes by 58% and 71% for people over 60 years old. (http://www.cdc.gov/diabetes/prevention/index.htm)The CDC Diabetes Prevention Recognition Program (DPRP) is the quality assurance arm of the National DPP. The DPRP plays a critical role in assuring that organizations can effectively deliver the evidence-based lifestyle change program with quality and fidelity. To achieve CDC recognition, organizations must provide evidence they are following a CDC-approved curriculum and achieving meaningful results with patients based on established national standards (http://www.cdc.gov/diabetes/prevention/recognition/about.htm). There are over 1,200 CDC-recognized organizations across 50 states, the District of Columbia, Puerto Rico, and the Virgin Islands delivering the evidence-based lifestyle change program in-person, virtually, or through a combination of virtual/in-person modalities to accommodate different learning styles and preferences. These organizations are listed on the DPRP website at (https://nccd.cdc.gov/DDT_DPRP/Programs.aspx).The National DPP works toward equal access to the lifestyle change program for all populations at risk. Currently, there are gaps in the national infrastructure related to reaching and serving particular priority populations. Medicare beneficiaries, people with disabilities, men, and racial/ethnic minorities are under-represented relative to their estimated numbers and disease burden. Many live in areas of the country with few or no programs. Where programs do exist, they often lack the expertise necessary to help these populations overcome barriers to successful completion of the program. This is an open competition funding opportunity announcement (FOA) that builds on successful strategies tested in previous FOAs to scale and sustain the National Diabetes Prevention Program (National DPP) for general populations. In this FOA, those strategies will be adapted for both general populations, Medicare benificiaries and one or more priority populations in underserved areas.Through a five-year cooperative agreement, CDC will support national or regional organizations with multi-state networks to deliver a CDC-recognized lifestyle change program in underserved areas to adult populations with prediabetes or at high risk for type 2 diabetes. Applicants must identify affiliate delivery sites in at least three states and enroll at least 1000 priority population participants in the first year. Continued growth in sites and participants is expected in years 2-5. Applicants must demonstrate the organizational capacity and experience working with affiliate sites and other key partners to implement and deliver a CDC-recognized lifestyle change program or other evidence-based behavior change program, including documenting program outcomes.Applicants must have demonstrated specialized experience working with general populations, Medicare beneficiaries and one or more priority populations in underserved areas to deliver a CDC evidence based lifestyle change program or other behavioral change program. Priority populations include men, African-Americans, Asian Americans, Hispanics, American Indians, Alaska Natives, Pacific Islanders, and non-institutionalized people with visual impairments or physical disabilities. These populations are prioritized because they have been enrolled in lifestyle change program at lower rates despite relatively higher rates of type 2 diabetes. To the extent the general population as well as priority populations have access and are enrolling, a reduction in incidence, or new cases, of type 2 diabetes is anticipated.Previous enrollment of priority population participants does not by itself constitute specialized experience. If applicants do not substantially meet this criteria, they may enter into a formal collaboration with one or more organizations that have this experience. These collaborations must be formalized through a memorandum of understanding (MOU) or memorandum of agreement (MOA) that details the respective roles of the applicant and each of the collaborating partners in implementing the required strategies and activities and in meeting the outcomes and performance measures outlined in this FOA. Awardees must implement activities in all 5 strategies: 1) Increase the availability of CDC-recognized organizations in underserved areas; 2) Increase clinician screening, detection, and referral of adults with prediabetes or at high risk for type 2 diabetes to CDC-recognized organizations; 3) Increase awareness of prediabetes and enrollment in the lifestyle change program; 4) Increase retention rates for participants in the lifestyle change program; 5) Increase benefit coverage for participation in the lifestyle change program. By the end of the cooperative agreement, delivery infrastructure will be expanded, closing the enrollment gap so that more priority population participants with prediabetes successfully complete the CDC lifestyle change program, achieve 5-7% weight loss, and significantly reduce their risk for developing type 2 diabetes. The announcement is only for non-research activities supported by CDC; applications for research cannot be considered through this announcement.

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