Diabetes Standards of Care and Resources for Clinicians and Educators
People can have prediabetes for many years, and a number of them develop will type 2 diabetes over time. Identifying people with prediabetes allows an opportunity to intervene and prevent or delay diabetes. Lifestyle change interventions, such as reducing weight and increasing physical activity, in American Indians and Alaska Natives (AI/ANs) with prediabetes can decrease the risk of progression to diabetes.
Clinical Practice Recommendations
Recommendations for Diabetes Prevention
Screening methods for people with prediabetes are described in Diagnosing Type 2 Diabetes and Identifying Prediabetes of the IHS Diabetes Standards of Care and Clinical Practice Resources.
Any of the following screening test results means that a person has prediabetes:
- A1C level of 5.7% to 6.4%
- Fasting plasma glucose level of 100 mg/dL to 125 mg/dL
- 2-hour plasma glucose value of 140 mg/dL to 199 mg/dL during a 75-gm oral glucose tolerance test
People with values in the upper ends of these test ranges have a greater risk of developing diabetes than people with values at the lower ends.
The National Institutes of Health-sponsored Diabetes Prevention Program (DPP) clinical trial found that an intensive lifestyle intervention (ILI) lowered diabetes incidence by 58% in individuals at high risk of diabetes.1 The 16-session ILI established a weight loss goal of 7% from baseline and a physical activity goal of 150 minutes per week. The size of the reduction in diabetes incidence with the ILI was similar in all racial subgroups, including American Indians.
The Diabetes Prevention demonstration projects of the Special Diabetes Program for Indians showed that a Native Lifestyle Balance Curriculum (modified 16-session, 6-month DPP ILI curriculum) could be successfully implemented in AI/AN communities.2
Resources on lifestyle intervention programs for diabetes prevention:
- The Diabetes Prevention Program Toolkit of the SDPI describes how to establish and implement a Diabetes Prevention Program (DPP).
- The Centers for Disease Control and Prevention (CDC) offers curricula and formal recognition of lifestyle change programs through the National DPP. Exit Disclaimer: You Are Leaving www.ihs.gov
- The Medicare Diabetes Prevention Program Expanded Model Exit Disclaimer: You Are Leaving www.ihs.gov offers reimbursement for Medicare beneficiaries participating in CDC-recognized diabetes prevention programs.
Medications can prevent or delay diabetes development. Metformin, an anti-hyperglycemic agent, reduced diabetes incidence by 31% in the National Institutes of Health DPP trial.1 Metformin is most effective for diabetes prevention in adults with prediabetes and any of the following characteristics:
- Body mass index of at least 35 kg/m2
- Age less than 60 years
- History of gestational diabetes mellitus
Note: Metformin is U.S. Food and Drug Administration (FDA)-approved for hyperglycemia treatment in people with type 2 diabetes, but not for diabetes prevention.
The medications listed below can prevent or delay diabetes in people with prediabetes, but they do not have FDA approval for diabetes prevention. Providers should discuss the risks and benefits of these agents with patients before prescribing them for diabetes prevention.
- Thiazolidinediones (pioglitazone)
- Alpha-glucosidase inhibitor (acarbose)
- Orlistat (Xenical), a lipase inhibitor
- Liraglutide (Saxenda), a glucagon-like peptide-1 receptor agonist
- Phentermine and topiramate combination (Qsymia), a sympathomimetic-antiepileptic medication
- Knowler W, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM; DPP Research Group. A randomized clinical trial to prevent type 2 diabetes in persons at high risk. N Engl J Med 2002;346:393-403. DOI: 10.1056/NEJMoa012512
- Jiang L, Manson SM, Beals J, Henderson WG, Huang H, Acton KJ, Roubideaux Y; Special Diabetes Program for Indians Diabetes Prevention Demonstration Project. Translating the Diabetes Prevention Program into American Indian and Alaska Native communities: Results from the Special Diabetes Program for Indians Diabetes Prevention demonstration project. Diabetes Care 2013;36:2027-2034. https://doi.org/10.2337/dc12-1250
Clinician and Educator Resources
Featured Diabetes Prevention Resources
National Diabetes Prevention Program:
American Diabetes Association. 3. Prevention or delay of type 2 diabetes and associated comorbidities: Standards of Medical Care in Diabetes 2022.Exit Disclaimer: You Are Leaving www.ihs.gov Diabetes Care 2022;45(Suppl.1):S39-S45. doi:10.2337/dc22-S003
Patient Education Resources
Diabetes Prevention Patient Education Resources
Many culturally relevant educational materials are available from the IHS Division of Diabetes Treatment and Prevention.
Native Lifestyle Balance (16-session curriculum with coaching videos and handouts contain valuable tools, but it has not been updated)
Diabetes Prevention CME Trainings
|Session Title||Session Material||CME/CE Information|
|New The Developmental Origins of Obesity and Diabetes Exit Disclaimer: You Are Leaving www.ihs.gov
Jonathan Q. Purnell, MD
Interim Director, Center for Preventive Cardiology
Professor, Department of Medicine
Knight Cardiovascular Institute
Division of Endocrinology, Diabetes, and Clinical Nutrition
Oregon Health & Science University
(Originally presented on 04/13/22.)
|New Engaging Communities in Type 2 Diabetes Prevention: The National Diabetes Prevention Program (National DPP) Exit Disclaimer: You Are Leaving www.ihs.gov
Miriam Bell, MPH
Kavitha Muthuswamy, MPH
Larry Alonso, RN, MSN, FNP-BC
Dawn Satterfield, PhD, MSN, RN
Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion
Division of Diabetes Translation
(Originally presented on 01/12/22.)
|New Investment in America’s Most Important Infrastructure: Promoting the Health and Wellness of Families with Young Children Exit Disclaimer: You Are Leaving www.ihs.gov
Matthew Hirschfeld, MD, PhD
Maternal Child Health Services
Alaska Native Medical Center
(Originally presented on 11/09/21.)
|Why Breastfeeding Support is a Shared Responsibility Exit Disclaimer: You Are Leaving www.ihs.gov
Jessica Quinlan, MPH, RD, CLC
Pueblo of Zuni WIC Program Nutrition Coordinator
Zuni Youth Enrichment Project Food Sovereignty Coordinator
(Originally presented on 08/25/21.)