The NCCC Report to Congress: Prevention in People with Prediabetes

Authors: BOLTRI, JOHN - Northeastern Ohio University; TRACER, HOWARD - Agency For Healthcare Research And Quality (AHRQ); STROGATZ, DAVID - Bassett Health Care Network; SCHUMACHER, PATRICIA - Centers For Disease Control And Prevention (CDC) - United States; Fukagawa, Naomi; SHELL, DONALD - Department Of Defense; WU, SAMUEL - US Department Of Health And Human Services (HHS); IDZIK, SHANNON - University Of Maryland School Of Medicine; HERMAN, WILLIAM - University Of Michigan; POWELL, CLYDETTE - George Washington University

Submitted to: Diabetes Care
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 11/3/2022
Publication Date: 1/30/2023
Citation: Boltri, J., Tracer, H., Strogatz, D., Schumacher, P., Fukagawa, N.K., Shell, D., Wu, S., Idzik, S., Herman, W., Powell, C. 2023. The NCCC Report to Congress: Prevention in people with prediabetes. Diabetes Care. 46(2):e39-e50. https://doi.org/10.2337/dc22-0620.
DOI: https://doi.org/10.2337/dc22-0620

Interpretive Summary: Diabetes mellitus is one of the major non-communicable diseases affecting a significant portion of the global population. Although over 96 million U.S. adults have prediabetes, less than half are ever diagnosed. A myriad of factors at the individual, community and societal levels influence diabetes risk and the treatment of the disease with minimal complications. Scientific research has demonstrated the efficacy of both intensive lifestyle interventions and prescribed medications (metformin) in preventing the progression of prediabetes to type 2 diabetes. Intervention in these early stages is crucial, as type 2 diabetes is irreversible and increases risk factors for other conditions, like heart disease and stroke. In this report, the National Clinical Care Commission (NCCC) subcommittee recommends targeted interventions for diabetic prevention that focus on: 1) increasing awareness of and the diagnosis of prediabetes on a population basis, 2) increasing the availability of, referral to, and insurance coverage for the National Diabetes Prevention Program and the Medicare Diabetes Prevention Program, 3) facilitating FDA review and approval of metformin for diabetes prevention, and 4) supporting research that benefits the etiological understanding of type 1 diabetes, enhancing overall disease prevention.

Technical Abstract: Although over 96 million U.S. adults have prediabetes, less than half are ever diagnosed. Risk factors for type 2 diabetes include the following: • Individuals considered overweight and obese, based on Body Mass Index (BMI). • An elevated fasting glucose level. • Impaired glucose tolerance (confirmed through a ‘post-glucose challenge glucose’). • Hemoglobin A1c levels below the diagnostic threshold for diabetes. • Women with histories of gestational diabetes (collectively termed prediabetes). Scientific research has demonstrated the efficacy of both intensive lifestyle interventions and prescribed medications (metformin) in preventing the progression of prediabetes to type 2 diabetes. Intervention in these early stages is crucial, as type 2 diabetes is irreversible and increases risk factors for other conditions, like heart disease and stroke. In this report, the National Clinical Care Commission (NCCC) subcommittee recommends targeted interventions for diabetic prevention that focus on: 1) increasing awareness of and the diagnosis of prediabetes on a population basis, 2) increasing the availability of, referral to, and insurance coverage for the National Diabetes Prevention Program and the Medicare Diabetes Prevention Program, 3) facilitating FDA review and approval of metformin for diabetes prevention, and 4) supporting research that benefits the etiological understanding of type 1 diabetes, enhancing overall disease prevention.