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Frequently Asked Questions
Prediabetes
Fast Facts
- Prediabetes is a condition that raises the risk of developing type 2
diabetes, heart disease, stroke, and eye disease. 1, 2
- People with prediabetes have impaired fasting glucose (IFG), impaired
glucose tolerance (IGT), or both—conditions where blood glucose levels are
higher than normal but not high enough to be classified as diabetes.1,
3
- People with prediabetes are 5-15 times more likely to develop type 2
diabetes than are people with normal glucose values. 4
- Progression to diabetes among those with prediabetes is not inevitable.
Studies show that people with prediabetes who lose at least 7% of their body
weight and engage in moderate physical activity at least 150 minutes per
week can prevent or delay diabetes and even return their blood glucose
levels to normal.1
- Clinical research shows intensive lifestyle interventions are the most
effective way to prevent or delay type 2 diabetes. 5
- About 54 million individuals in the United States aged 21 years and
older have
prediabetes2, 12 million of whom are overweight and between the ages of
45–74. 6
- In the United States, approximately one of every three persons born in
2000 will develop diabetes in his or her lifetime. The lifetime risk of
developing diabetes is even greater for ethnic minorities: two of every five
African Americans and Hispanics, and one of two Hispanic females, will
develop the disease.3
What is prediabetes?
People with blood glucose levels that are higher than normal but not yet
in the diabetic range have "prediabetes." Doctors sometimes call this
condition impaired fasting glucose (IFG) or impaired glucose tolerance (IGT),
depending on the test used to diagnose it. Insulin resistance and prediabetes usually have no symptoms. You may have one or both conditions
for several years without noticing anything.
How is prediabetes detected?
At present, the fasting plasma glucose (FPG) and the 2-h oral glucose
tolerance test (OGTT) are the tests of choice to identify all states of
hyperglycemia. Either test is suitable, and each has advantages and
disadvantages, such as convenience, cost, and reproducibility.
Identification of individuals with IGT can be made only with a 2-hour OGTT;
the fasting plasma glucose (FPG) alone will miss approximately 30% of
patients with isolated IGT. A recent consensus statement issued by the
American Diabetes Association has recommended that if pharmacotherapy is
used, both IFG and IGT should be documented. If only lifestyle modification
is planned, a confirmatory test is not required.5,4
- IGT is detected when blood glucose levels are elevated (140–199
mg/dL) two hours after an Oral Glucose Tolerance Test is administered.
- • IFG is detected when blood glucose levels are elevated (100–125 mg/dL) after a fast of at least eight hours.
See Table 1 for the tests and corresponding glucose values used to
identify IGT and IFG.
Table 1 -
Identifying Prediabetes:
IGT and IFG[7]
Condition/Classification |
Test Used and Diagnostic Values |
Impaired Glucose Tolerance (IGT) |
- Oral Glucose Tolerance Test (OGTT), 75 grams of glucose
- 2-hour plasma glucose = 140–199 mg/dL
|
Impaired Fasting Glucose (IFG) |
- Fasting plasma glucose (FPG) after 8-hour fast
- Fasting plasma glucose = 100–125mg/dL
|
How does prediabetes relate to the future diabetes burden?
About 54 million individuals in the United States aged 21 years and
older have
prediabetes,3 nearly 12 million of whom are overweight and between the
ages of 45–74.6 In addition to the nearly 21 million individuals in the
United States currently diagnosed with diabetes, the estimated number of
diagnosed cases of diabetes will increase in the United States by 198% in the
next 50 years—with the largest increase occurring among African
Americans, American Indians, and Hispanic/Latino Americans.8
What are the guidelines for prediabetes screening?
Screening for prediabetes (IFG/IGT) is fundamentally no different from
screening for diabetes because the same risk factors are associated with
both conditions.5,9 See Table 2 for specific recommendations for prediabetes screening, as well as relevant prediabetes/type 2 diabetes
risk factors.
Table 2 — Prediabetes Screening Guidelines
Recommending Body |
Prediabetes risk factors and screening guidelines |
American Diabetes Association
(ADA)
|
Recommended tests: FPG or 2-h OGTT
1. All persons ≥45 years of age, particularly
in those who are overweight (BMI>25kg/m2), and repeated every three
years
2. Persons <45 years of age who are overweight
(BMI>25kg/m2) with any one of the following risk factors:9
Habitually physically inactive
|
High-density lipoprotein (HDL) cholesterol < 35 mg/dl and/or
triglyceride level > 250 mg/dl
|
First-degree relative with diabetes |
Polycystic ovary syndrome (PCOS)
|
Member
of high-risk ethnic population (e.g. African American,
Latino, Native American, Asian American, Pacific Islander)
|
Impaired glucose tolerance (IGT) or impaired fasting glucose
(IFG) on previous testing
|
Delivered a baby weighing >9lbs. or have been diagnosed with
gestational diabetes |
Other clinical conditions
associated with insulin resistance (e.g., PCOS or acanthosis
nigricans)
|
Hypertensive (blood pressure ≥140/90 mmHG) |
History of vascular disease |
|
Indian Health Services (IHS) |
Recommended tests: FPG in the morning or
2-hr OGTT
1. Annual testing of American Indian and Alaska
Native adults aged 19 years and older with any of the following
risk factors for diabetes:7
BMI ≥25
kg/m2
|
Women
with a history of gestational diabetes
|
Hypertension
|
Women
with Polycystic Ovarian Syndrome (or Hyperandrogenic Chronic
Anovulation)
|
High-density lipoprotein <40 mg/dl in men or <50mg/dl in
women
|
Family
history of type 2 diabetes |
Triglycerides >150mg/dl |
|
2. Testing every three years beginning at age
35 for those without the above risk-factors |
* The U.S Preventive Services Task Force also makes recommendations related to screening for diabetes and that recommendation can be found at:
http://www.ahrq.gov/clinic/uspstf/uspsdiab.htm
Do risk factors for prediabetes differ from type 2 diabetes?
No, risk factors for prediabetes do not differ from type 2 diabetes. Both
conditions share the same risk factors, and prediabetes is itself a risk
factor for type 2 diabetes.5,9 See Table 2 for prediabetes/type 2 diabetes
risk factors.
While prediabetes and type 2 diabetes share the same risk factors,
persons with prediabetes can reduce their blood glucose levels to normal
values and reduce their risk for developing type 2 diabetes. Currently,
there is not enough information to warrant distinguishing prediabetes and
diabetes’ risk factors. As we learn more about the differing
pathophysiologies of IGT and IFG and their relation to the onset of type 2
diabetes, as well as preventive interventions, distinguishing prediabetes
and type 2 diabetes risk factors might become possible.
What is the risk of a person’s prediabetes converting into type 2
diabetes?
The risk of progressing to diabetes depends on the type of prediabetes
that a person has (IFG only, IGT only, or both), as well as other diabetes
risk factors. Individuals with prediabetes who are older, overweight, and
have a family history of diabetes and gestational diabetes are more likely
to progre–ss to diabetes.5 Individuals with prediabetes are
5-15 times more likely to develop type 2 diabetes than are people with
normal glucose values.4 Individuals with both IFG and IGT develop
diabetes approximately twice as often as individuals with just one of the
two conditions.5
Annual progression to diabetes
Studies in the United States and abroad show that, for persons with IGT,
between 2% and 34% will develop type 2 diabetes annually; for persons with
IFG, between 1.5% and 23% will develop diabetes annually.4 Two
randomized controlled trials of diabetes prevention, the Diabetes Prevention
Program (DPP) and the Finish Diabetes Prevention Study, demonstrated that
3–5% of individuals with IGT who lost weight and engaged in moderate
physical activity progressed to diabetes annually. For persons with
prediabetes who did not lose weight and engage in moderate physical
activity, 11% progressed to diabetes annually.10-11
Prolonged progression to diabetes
The natural history of prediabetes (both IGT and IFG) indicates that about
25% of persons with prediabetes progress to diabetes within three to five
years. With longer observation, the majority of individuals with IFG or IGT
go on to develop diabetes5 within about 10 years, unless they
lose weight through moderate changes in diet and physical activity.12
Over the course of a lifetime, as many as 83% of persons with prediabetes (IGT)
who neither lose weight nor engage in moderate physical activity will
develop diabetes.13 Over the course of a lifetime, approximately
65% of persons with prediabetes who lose weight and engage in moderate
physical activity will go on to develop diabetes13- 14
Progression to diabetes among the general population in the United States
The annual risk of developing diabetes for the average person living in the
United States with normal glucose levels is about 0.7% per year.15
For individuals born in the United States in 2000, the estimated lifetime
risk of being diagnosed with diabetes is roughly 1 of 3 for males and 2 of 5 for females. The lifetime risk of diabetes is even greater for
ethnic minorities: 2 of 5 African Americans and Hispanics, and 1 of 2 Hispanic females, will develop the disease.3 With
lifestyle changes, this course can be changed.
Is conversion to type 2 diabetes inevitable? What are intervention
strategies for preventing or delaying the conversion of prediabetes to
diabetes?
Interventions to prevent or delay prediabetes from progressing to type 2
diabetes can be feasible and cost-effective, and many individuals in the
United States could benefit from them, particularly those who are overweight
or obese.16
Developing type 2 diabetes is not inevitable. A variety of clinical
trials demonstrate that individuals with prediabetes can prevent or delay
the progression to diabetes through lifestyle and some pharmaceutical
interventions. These studies demonstrate that persons at risk for diabetes
can be identified early in the disease progression, before exhibiting blood
glucose values indicative of diabetes. Those individuals who lose weight and
increase their physical activity can prevent or delay the development of
diabetes. Moderate-intensity lifestyle interventions can delay development
of type 2 diabetes by an average of 11 years and reduce the number of new
cases of type 2 diabetes by 20%. Pharmacological interventions has
shown to delay the onset of type 2 diabetes by an average of three years
while reducing the number of new cases of type 2 diabetes by 8%.13
Lifestyle Intervention Strategies
Lifestyle changes can prevent or delay the onset of type 2 diabetes among
high-risk adults. This has been shown in studies that included people with
IGT and other high-risk characteristics for developing diabetes. Lifestyle
interventions included low fat diet and moderate-intensity physical activity
(such as walking for 2 1/2 hours each week). In the DPP, a large prevention
study of people at high risk for diabetes, the development of diabetes was
reduced by 58% over 3 years.17
See Table 3 for key aspects of the DPP lifestyle protocol. A
comprehensive description of the DPP, including the lifestyle protocols,
lifestyle manuals and an updated list of DPP-related publications can be
found at http://www.bsc.gwu.edu/dpp/index.htmlvdoc*.
Other studies have shown lifestyle education (dietary + exercise or
dietary alone) can reduce 2-hour plasma glucose levels as well as the onset
of type 2 diabetes among those at risk by as much as 50%.18 A listing of these
lifestyle interventions can be found in Table 4.
Table 3 — DPP Lifestyle Protocols19
Clearly defined weight loss and physical activity goals |
A flexible maintenance program |
Individual case managers or “lifestyle coaches” |
Culturally-appropriate materials and strategies |
Intensive, ongoing intervention |
Local and national network of training, feedback and clinical support |
A core curriculum |
Supervised exercise sessions at least twice
weekly
|
Table 4 — Lifestyle education interventions for type 2 diabetes
prevention18
Type of Intervention |
Dietary Education
|
Exercise Education |
Dietary + exercise |
Reducing energy intake |
Increase leisure physical exercise by one of more of the following
examples: 30 extra minutes per day of slow walking; 20 extra minutes per day
of brisk walking; 10 extra minutes per day of jogging; 5 extra minutes per
day of jumping rope, playing basketball or swimming. |
Dietary + exercise |
Standard diet advice sheet with telephone contact (three per month) |
Emphasizing need for regular
exercise |
Dietary + exercise |
Low-fat, high-fiber diet |
Regular exercise with a program implemented during a 1-month stay at a wellness center that included intense dietary learning sessions |
Dietary + exercise |
Regular diet counseling from a dietician |
Physical activity counseling from a physiotherapist |
Dietary + exercise |
Individualized dietary counseling from a nutritionist |
Circuit-type resistance training sessions and advice on increasing overall physical activity |
Dietary + exercise |
Regular dietary advice |
Stimulated to lose weight and increase physical activity with visits scheduled at regular intervals |
Dietary + exercise |
Weight-reduction through a healthy low-calorie, low-fat diet |
Engage in physical activity of moderate intensity by individualized curriculum by case managers |
Dietary alone |
Reduced-fat diet and participation in monthly small-group education session for
one year |
|
Dietary alone |
Reducing energy intake, especially at dinner |
|
Pharmacotherapy strategies
The drug metformin is effective in delaying or preventing conversion of
prediabetes to diabetes. However, it is not as effective as the
lifestyle intervention. While the lifestyle intervention reduced
diabetes onset by 58%, metformin reduced onset by 31%.10
Several clinical trials have shown reductions in the incidence of
diabetes with different pharmacotherapies, though their longer-term
effectiveness remains unknown. For example, rosiglitazone is a newer
drug that has been shown to reduce the incidence of diabetes in 60% of
individuals with elevated blood glucose levels over the reduction
observed in a placebo group.20 While this drug could be effective,
the main clinical trial did not compare this treatment to lifestyle
change or other drugs. Rosiglitazone can have side effects; these
include headaches, back pain, fatigue, hypoglycemia, hyperglycemia, and
upper respiratory tract infections. A major side effect of rosiglitazone
was an increased incidence of cardiovascular events, including a 7-fold
increase in heart failure over what was observed in those receiving a
placebo.20 Also, acarbose (another drug) was shown to delay progression
to type 2 diabetes in patients with IGT by 25% over 3.3 years.21
Researchers also observed a greater than 50% reduction in the incidence
of type 2 diabetes in Hispanic women who were treated with troglitazone,
an insulin-sensitizing drug. These women continued to experience the
protective benefits from diabetes eight months after the drug was
stopped.22 Troglitazone was removed from the market due to safety
concerns. As questions remain regarding the long-term efficacy and
cost-effectiveness of pharmaceutical interventions for prediabetes,
experts continue to recommend diet and exercise as the most effective
preventive approach for people with prediabetes.5,9,20,23
Are Prevention Interventions Cost-Effective?
Interventions to prevent or delay prediabetes from progressing to
type 2 diabetes can be feasible and cost-effective. Many individuals in
the United States, particularly those who are overweight or obese,16
could benefit from such interventions. As shown in Table
5, research from the DPP found
that lifestyle interventions are more cost-effective than
pharmacological agents.13,24
Table 5
DPP Findings on Cost-Effectiveness of Interventions
Lifestyle Intervention Strategies |
Pharmacological Agent (metformin)
|
- Delayed development of type 2 diabetes by an average of 11 years
- Reduced the number of new cases of type 2 diabetes by 20%
- Over time could be predicted to result in cost per Quality Adjusted
Life Year (QALY)a of approximately $1,100 from a health
system perspectiveb and $8,800 from a societal
perspectivec13
- During the DPP study period, direct medical cost for care received
outside the study was $432 lower per participant after receiving the
lifestyle change intervention than for a placebo group that did not
receive any intervention.24 Within the trial period, the
lifestyle change intervention cost $16,000 per case of diabetes
prevented and $32,000 per QALY.13
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- Delayed onset of diabetes by an average of three years
- Reduced the number of new cases of type 2 diabetes by 8%
- Resulted in higher costs per Quality Adjusted Life Year (QALY)a than the
lifestyle change intervention – costs per QALY for individuals receiving
metformin were approximately $31,300 from a health system perspectiveb
and $29,900 from a societal perspectivec13
- During the program period, direct medical cost for care received outside
the study for the metformin group was $272 lower per participant than a
placebo group not receiving any intervention.24 Within the trial
period, metformin cost $31,000 per case of diabetes prevented and $100,000
per QALY.13
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a A
QALY measures the cost to extend life by one healthy year. It
measures not only years of life gained but also the quality of those
life years.
b The
health system perspective includes the cost of treatment (e.g.,
clinician time and medication cost).
c The
societal perspective includes costs to society (e.g., indirect costs
such as lost productivity and taxes paid for health care and disability,
direct non-medical costs related to lifestyle changes).
The American Diabetes Association supports lifestyle
modification as the best method of treating prediabetes because there is
insufficient evidence to support the cost-effectiveness of medication
interventions.9
The completed prevention trials indicate that an intensive
lifestyle intervention provides the greatest reduction in the occurrence
of diabetes, along with a modest reduction in cardiovascular disease
risk factors.5
Assessing costs and savings can be a challenge in determining
the best strategies for preventing diabetes among those with prediabetes.
For example, lifestyle changes are usually paired with medical
treatment, making it difficult to decipher which prevention strategy is
most cost effective.25 Also, the brief duration of some
trials limits the ability to determine long-term effects, such as
morbidity (complications) or mortality.25-26
What are Current Reimbursement Strategies for Prediabetes Care?
Insurance plans differ in reimbursement for diabetes and prediabetes
screening and treatment. Most insurance plans cover testing for people
suspected of having diabetes. Becausethe tests and risk factors are the
same for both conditions, a prediabetes test may be covered.
Medicare
As of 2005, the Centers for Medicare and Medicaid Services (CMS)
cover screening tests for diabetes for those who have been diagnosed
with prediabetes. The CMS policy covers the following:
- Two diabetes screening tests per year for individuals with diagnosed prediabetes.
- One diabetes screening test per year for individuals who were never
tested or whose test results were negative for prediabetes.
Covered tests include the fasting blood glucose (FBG) test and the
post-glucose challenge test (OGTT). Medicare-covered diabetes screening
tests do not require co-payments, deductibles, or coinsurance from the
Medicare member.27
Individuals who have any one of the following risk factors for
diabetes are eligible for the CMS benefit:
- Hypertension (high blood pressure)
- Dyslipidemia (high cholesterol)
- Obesity (a body mass index ≥30 kg/m2)
- Elevated impaired fasting glucose intolerance
OR
Individuals who have at least two of the following characteristics:
- Overweight (a body mass index of 25–29 kg/m2)
- A family history of diabetes
- Age 65 or older
- A history of gestational diabetes
- Delivery of a baby weighing >9 lbs
Medicaid
Medicaid, the combined federal and state health insurance program for the
poor and disabled, has no national-level requirements around screening
or treatment for diabetes or prediabetes, though all states and Medicaid
plans must cover physician, hospital, and lab services. Generally, the
Medicaid program covers most diabetes medications but may not always
cover diabetes education services, insulin pumps or prediabetes
screening.28 Medicaid coverage rules are set at the state level and vary
from state to state.
Private Insurance
Private insurance generally consists of group (i.e., self-insured,
employer-sponsored health insurance) and individual coverage. Individual
coverage is subject to state insurance laws and mandates. As of December
2005, 46 states had laws requiring coverage of diabetes treatment in
private insurance plans.29 Employer-sponsored health plans
that are self-insured are exempt from these mandates through the
Employee Retirement Income Security Act of 1974 (ERISA), so coverage of
diabetes services varies greatly.
References
- Centers for Disease Control and Prevention. National Diabetes Fact Sheet,
United States, 2005. [Cited 2006 Nov 3]. Available from:
http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2005.pdf.
(PDF – 54 KB) — Learn more about
PDFs
- Diabetes Prevention Program Research Group. The prevalence of retinopathy in
impaired glucose tolerance and recent-onset diabetes in the Diabetes
Prevention Program Diabet. Med. 2007;24:137–144.
- Centers for Disease Control and Prevention Coordinating Center for
Health Promotion. Diabetes: Disabling, Deadly, and on the Rise, 2007.
[Cited 2007 April 2]. Available from:
http://www.cdc.gov/nccdphp/publications/aag/ddt.htm.
- Santaguida PL, Balion C, Hunt D, et al. Diagnosis, prognosis, and
treatment of impaired glucose tolerance and impaired fasting glucose.
Summary, Evidence Report/Technology Assessment No. 128. (Prepared by the
McMaster Evidence-based Practice Center under Contract No. 290-02-0020).
AHRQ Pub. No. 05-E026-1. Rockville, MD: Agency for Healthcare Research
and Quality. August 2005.
- Nathan DM, Davidson MB, Defronzo RA, Heine RJ, Henry RR, Pratley R, Zinman
B. Impaired fasting glucose and impaired glucose tolerance. Diabetes Care.
2007;30:753–759.
- Benjamin SM, Valdez R, Geiss LS, et al. Estimated number of adults with
pre-diabetes in the United States in 2000: Opportunities for prevention.
Diabetes Care. 2003;26(3):645–9.
- Indian Health Service. IHS Guidelines for Care of Adults with Prediabetes
and/or the Metabolic Syndrome in Clinical Settings. April 2005.
- Narayan VKM, Boyle JP, Geiss LS, Saaddine JB, Thompson TJ. Impact of recent
increase in incidence on future diabetes burden. Diabetes Care. 2006;29:2114–2116.
- American Diabetes Association. Position statement: Standards of medical care
in diabetes-2007. Diabetes Care. 2007;30(Suppl 1):S4–S40.
- Knowler WC, Barrett-Conner E, Fowler SE, Hammon RF, Lachin JM, Walker EA,
Nathan DM, the Diabetes Prevention Program Research Group: Reduction in the
incidence of type 2 diabetes with lifestyle intervention or metformin. NEJM.
344:393–403, 2002
- Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H,
Ilanne-Parikka P, Keinanen-Kiukaanniemi S, Laasko M, Louheranta A, Rastas M,
Salminen V, Uusituupa M, the Finnish Diabetes Prevention Study group;
Prevention of type 2 diabetes with lifestyle intervention or metformin. NEJM.
2001;344:1343–1350.
- Centers for Disease Control and Prevention (CDC). Frequently Asked
Questions: Preventing Diabetes. [Accessed 2007 Apr 19]. Available from:
http://www.cdc.gov/diabetes/faq/preventing.htm#5.
- Herman WH, Hoerger TJ, Brandle M, et al. The cost-effectiveness of lifestyle
modification or metformin in preventing type 2 diabetes in adults with
impaired glucose tolerance. Annals of Internal Medicine 2005;142:323-332.
- DeVegt F, Dekker JM, JagerA, Hienkens E, Kostense PJ, Stehouwer CD, Nijpets
G, Bouter LM, Heine RJ: Relations of impaired fasting and postload glucose
with incident type 2 diabetes ina Dutch populations: the Hoorn Study. JAMA
2001;285:2109-2113.
- National Diabetes Surveillance System. Incidence of Diabetes: Crude and
Age-Adjusted Incidence of Diagnosed Diabetes per 1000 Population Aged 18-79
Years, United States, 1997–2004, [Accessed 2007, April 17]
http://www.cdc.gov/diabetes/statistics/incidence/fig2.htm.
- Kanaya AM, Narayan KM. Prevention of type 2 diabetes: data from recent
trials. Primary Care 2003;30(3):511–26. Centers for Disease Control and Prevention (CDC). National Diabetes Fact
Sheet. [Accessed 2007 Apr 19]. Available from:
http://www.cdc.gov/diabetes/pubs/general.htm#impaired.
- Centers for Disease Control and Prevention (CDC). National Diabetes
Fact Sheet. [Accessed 2007 Apr 19]. Available from:
http://www.cdc.gov/diabetes/pubs/general.htm#impaired.
- Yamaoka K, Tango T. Efficacy of lifestyle education to prevent type 2
diabetes: a meta-analysis of randomized controlled trials. Diabetes Care.
2005; 28:2780-2786.
- Diabetes Prevention Program (DPP) Research Group. The diabetes prevention
program (DPP): Description of lifestyle intervention. Diabetes Care. 2002;
25:2166.
- Diabetes Reduction Assessment with Ramipril and Rosiglitazone Medication
Trial Investigators. Effect of rosiglitazone on the frequency of diabetes in
patients with impaired glucose tolerance or impaired fasting glucose: A
randomized controlled trial. The Lancet 2006;368(9541):1096–1105.
- Chiasson JL, Josse RG, Gomis R, et al. Acarbose for prevention of type 2
diabetes mellitus: The STOP-NIDDM randomized trial. The Lancet
2002;359:2072–2077.
- Buchanan TA, Xiang AH, Peters RK, et al. Preservation of pancreatic beta
cell function and prevention of type 2 diabetes by pharmacological treatment
of insulin resistance in high-risk Hispanic women. Diabetes
2002;51:2796-2803.
- American Diabetes Association and National Institute of Diabetes,
Digestive and Kidney Diseases. Position statement: The prevention or
delay of type 2 diabetes. Diabetes Care. 2002;25(4):742–9.
- The Diabetes Prevention Program Research Group. Costs associated
with the primary prevention of type 2 diabetes mellitus in the Diabetes
Prevention Program. Diabetes Care. 2003;26:36–47.
- Thomas DE, Elliott EJ, Naughton GA. Exercise for type 2 diabetes
mellitus. Oxford, UK: The Cochrane Collaboration. [Cited 2006 Sept 21].
Available from:
http://www.cochrane.org/reviews/en/ab002968.html*.
- Satterfield DW, Volansky M, Caspersen CJ, et al. Community-based
lifestyle interventions to prevent type 2 diabetes. Diabetes Care.
2003;26(9):2643–2652.
- Centers for Medicare and Medicaid Services Medicare Learning
Network. MLN Matters, No. SE0660. [Cited 2006 Nov 14]. Available from:
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0660.pdf.
(PDF – 7 1KB) — Learn more about
PDFs
- National Diabetes Education Program. What we want to achieve through
systems changes. Patient-centered care: Health insurance coverage for
diabetes. [Cited 2006 Nov 13]. Available from:
http://www.betterdiabetescare.nih.gov/WHATpatientcenteredcoverage.htm.
- National Conference of State Legislatures. State laws mandating
diabetes health coverage. [Updated 2006 Sept; cited 2006 Nov 13].
Available from:
http://www.ncsl.org/programs/health/diabetes.htm*.
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Page last reviewed: December 3, 2008
Page last modified: July 8, 2008
Content Source: National Center for Chronic Disease Prevention and Health Promotion
Division of Diabetes Translation
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