Key points
- As a pharmacist, you can help determine if your patients are eligible for screening for the National Diabetes Prevention Program (National DPP) lifestyle change program.
- You can use the Prediabetes Risk Test, administer a blood glucose test, or refer patients to their primary care provider for a blood glucose test. You can then refer or enroll eligible patients into a National DPP lifestyle change program.
Screen
Screening for prediabetes is the first step that pharmacists can take to determine if the National DPP lifestyle change program is appropriate for their patients. You can use these screening tests to start conversations with your patients about risk factors and recommended next steps.
The Prediabetes Risk Test can be completed online in 1 minute or it can be printed and filled out by hand.
Tips for screening patients
- Use waiting time to administer the paper risk test.
- Consider giving the test verbally instead of giving patients a paper copy to fill out. This approach may help establish a connection with patients and make it easier to personalize your recommendations. The risk test typically takes about 1 minute to complete.
- It's better for people to enroll in the National DPP on the basis of blood glucose test results. You should encourage a blood glucose test for any patient who scores high on the risk test.
- All adults can take the prediabetes risk test. Encourage patients who have health conditions that may put them at higher risk of prediabetes to take the test.
- Administer a blood glucose test to all patients who score high on the risk test or refer them to a health care provider for blood glucose testing.
Test
A blood glucose test is the best way to determine if a patient is at risk of developing type 2 diabetes. If you cannot offer a blood glucose test, refer patients with a high score on the prediabetes risk test to a clinical partner or their primary care provider for confirmatory blood glucose testing.
Table 1 provides information about the tests used to identify prediabetes and the follow-up actions recommended depending on the results.
Blood glucose tests to identify prediabetes and follow-up action
| Results | HbA1C Test | Fasting Plasma Glucose Test | Plasma Glucose Test 2 Hours After a 75 gm Glucose Load | Follow-Up Action |
|---|---|---|---|---|
| Normal | <5.7% | <100 mg/dL | <140 mg/dL | Encourage patient to maintain a healthy lifestyle. |
| Prediabetes | 5.7%–6.4% | 100–125 mg/dL* | 140–199 mg/dL | Refer patient to a primary care provider and an LCP delivered by a CDC-recognized organization. |
| Diabetes | ≥6.5% | ≥126 mg/dL | ≥200 mg/dL | Refer patient to a primary care provider for confirmatory diagnosis, diabetes self-management education and support, and treatment if appropriate. |
Refer
If you identify patients with prediabetes, you can use motivational interviewing, goal setting, problem solving, and cultural sensitivity to guide patients toward enrollment in the lifestyle change program.
If your patients have a high risk of developing type 2 diabetes, or a high risk test score, refer them to both of the following:
- Primary care provider: Tell the patient's primary care provider about screening or blood glucose test results so the diagnosis can be confirmed, documented, and managed. Refer patients to a nearby primary care provider if they do not already have one.
- Lifestyle change program: Establish relationships with organizations that offer the lifestyle change program nearby or online. Take time to understand their processes and policies so you can refer eligible patients to a program.
Program costs
If you refer a patient to the National DPP lifestyle change program, they may ask about the cost. There is no fixed cost to participate. Some organizations offer the program for free, while others charge a fee. Some employers and insurance carriers, as well as Medicare, offer the program as a covered health or wellness benefit.
You can recommend that your patients contact their employer or insurance provider to find out if they cover this type of program.
Enroll
Eligibility to enroll in the National DPP lifestyle change program
Organizations can accept referrals based on the results of a risk test alone. However, eligibility may vary according to the individual program or the policies of the payers.
If the organization is a Medicare Diabetes Prevention Program (MDPP) supplier, they may require blood sugar testing. Participant eligibility and enrollment requirements for MDPP suppliers are noted throughout this section. For more information about MDPP, visit the MDPP Expanded Model website.
Criteria for enrollment
All participants must:
- Be at least 18 years old AND not be pregnant at the time of enrollment.
- Have overweight with a body mass index ≥25kg/m2 (≥23kg/m2 if an Asian person).
AND not have a previous diagnosis of type 1 or type 2 diabetes before enrollment.
A minimum of 35% of participants must:
- Have a blood glucose test result in the prediabetes range within the past year or a claim code indicating that they have prediabetes according to:
- HbA1C of 5.7% to 6.4% or
- Fasting plasma glucose of 100 to 125 mg/dL (Note: eligibility requirement for MDPP participants is 110 to 125 mg/dL.) or
- Plasma glucose of 140 to 199 mg/dL measured 2 hours after a 75 gm glucose load. OR
- Have been clinically diagnosed with gestational diabetes mellitus during a previous pregnancy (may be self-reported). (Note: History of gestational diabetes is not included in the MDPP eligibility criteria.)
A maximum of 65% of participants may:
- Enroll on the basis of high-risk score according to the Prediabetes Risk Test.
To be enrolled in MDPP:
- Participants cannot self-report blood test results. Lab results must be provided. Blood test results must meet one of the following specifications:
- HbA1C of 5.7% to 6.4%.
- Fasting plasma glucose of 110 to 125 mg/dL or
- Plasma glucose of 140 to 199 mg/dL measured 2 hours after a 75 gm glucose load or
- For more information, see the MDPP Eligibility Fact Sheet.
Case study
American Pharmacists Association Foundation and National Community Pharmacy Association Support the National DPP Lifestyle Change Program
From 2017 to 2022, the American Pharmacists Association Foundation (APhA Foundation) worked with community pharmacies to reach people with limited resources. In 2022, the foundation partnered with the National Community Pharmacy Association (NCPA) to pilot the expansion of this community pharmacy model, called the STARS (Screen, Test, and Referral Solutions) program.
The pilot program used financial incentives for pharmacies to screen, test, refer, and enroll participants in the National DPP lifestyle change program. This approach recognizes that some pharmacies may not have the time or expertise to offer classes, but they can promote the program for people who can benefit. The STARS program also recognizes there are often more classes (especially through distance learning) available than there are people who enroll.
Tier 2 in Action: Screen, Test, Refer, and Enroll Patients
Community pharmacies are an ideal and trusted point of care for many patients who need help addressing their health care needs. Community pharmacy staff are also knowledgeable and experienced in screening and referring people at risk for type 2 diabetes to the services they need.
Since 2022 of the STARS program, the APhA Foundation and NCPA have successfully contracted with 25 community pharmacies in 11 states. They have enrolled a combined 300 participants in the National DPP lifestyle change program.