Diabetes Standards of Care and Resources for Clinicians and Educators
Diabetes Prevention
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.
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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.
Lifestyle Interventions
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.
Metformin
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.
Other Medications
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.
Antidiabetes medications:
- Thiazolidinediones (pioglitazone)
- Alpha-glucosidase inhibitor (acarbose)
Weight-loss medications:
- Orlistat (Xenical), a lipase inhibitor
- Liraglutide (Saxenda), a glucagon-like peptide-1 receptor agonist
- Phentermine and topiramate combination (Qsymia), a sympathomimetic-antiepileptic medication
References
- 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
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Diabetes Treatment Algorithm:SDPI Toolkits: |
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National Diabetes Prevention Program: |
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Medicare Diabetes Prevention Program (MDPP) Basics Exit Disclaimer: You Are Leaving www.ihs.gov |
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American Diabetes Association. 3. Prevention or Delay of Type 2 Diabetes and Associated Comorbidities: Standards of Care in Diabetes 2023.Exit Disclaimer: You Are Leaving www.ihs.gov Diabetes Care 2023;46(Suppl. 1):S41-S48. doi:10.2337/dc23-S003 |
Patient Education Resources
Diabetes Prevention Patient Education Resources
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Many culturally relevant educational materials are available from the IHS Division of Diabetes Treatment and Prevention. |
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Native Lifestyle Balance (16-session curriculum with coaching videos and handouts contain valuable tools, but it has not been updated) |
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Native Diabetes Wellness Program Exit Disclaimer: You Are Leaving www.ihs.gov Prevent Type 2 Diabetes Exit Disclaimer: You Are Leaving www.ihs.gov |
CME Training
Diabetes Prevention CME Trainings
| Session Title | Session Material | CME/CE Information |
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Health Coaching: Practitioner Perspectives in Improving Health Outcomes Exit Disclaimer: You Are Leaving www.ihs.gov
Jill Breyen, MS,RDN,CDCES, Health and Wellness CoachRed Lake Comprehensive Health Services Red Lake Indian Hospital (Originally presented on 09/06/23) |
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New An Overview of "On the TRAIL to Diabetes Prevention" Exit Disclaimer: You Are Leaving www.ihs.gov
Carla KnappNational Vice President, Native Services, Boys Girls Clubs of America Kelly Crowe Sr. Director Federal Grants Impact and Performance, Boys & Girls Clubs of America (Originally presented on 08/23/23) |
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New Insulin Resistance: Explanations and Treatment Approaches Exit Disclaimer: You Are Leaving www.ihs.gov
Rachel Blair, MDAssociate Physician and Instructor of Medicine Margo Hudson, MD Associate Physician and Assistant Professor of Medicine Brigham and Women’s Hospital, Harvard Medical School (Originally presented on 07/05/23) |
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Michelle Archuleta, MA, MS Public Health Advisor, CHR Program Lead HQs Indian Health Service Alyssa Fine, RN, MSN, CDCES, CNL Wellness & Diabetes Program Coordinator, Cowlitz Indian Tribe Health Clinic LCDR, US Public Health Service (Originally presented on 05/24/23) |
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New Cardiovascular Risk Stratification in American Indians Exit Disclaimer: You Are Leaving www.ihs.gov
Jason Deen, MDCo-Principal Investigator Associate Professor of Pediatrics and Medicine Divisions of Cardiology University of Washington School of Medicine (Originally presented on 02/01/23.) |
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New The Impact of Social Determinants of Health on Type 2 Diabetes in Indigenous Communities Exit Disclaimer: You Are Leaving www.ihs.gov
Dr. Melissa WallsBloomberg Associate Professor of American Health (Originally presented on 12/21/22.) |
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New An All-of-Government Approach to Diabetes Prevention and Control: Report from the 2022 Federal Diabetes Commission Exit Disclaimer: You Are Leaving www.ihs.gov
Dean Schillinger MDUCSF Professor of Medicine in Residence Division of General Internal Medicine (Originally presented on 11/09/22.) |
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New Case Management: Practicing Population Health to Engage Patients as Partners in Care Exit Disclaimer: You Are Leaving www.ihs.gov
Krista Haven, RN, MSN, CDEDiabetes Nurse Specialist (Originally presented on 11/02/22.) |
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New Using the Nutrition Facts Label to Achieve the Healthy People 2030 Goals Exit Disclaimer: You Are Leaving www.ihs.gov
Mark A. Kantor, Ph.D.Nutrition Scientist (Originally presented on 10/19/22.) |
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New Diabetes Prevention and Culture Revitalization through Breastfeeding and Chestfeeding Exit Disclaimer: You Are Leaving www.ihs.gov
Kimberly Moore-Salas, IBCLCPresident/Consultant Tribal Indemnity, LLC Amanda Singer, CLC, Indigenous Doula Executive Director Navajo Breastfeeding Coalition (Originally presented on 08/31/22.) |
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New The Social Determinants of Health: How the Context in Which We Live Impacts Health Exit Disclaimer: You Are Leaving www.ihs.gov
Jana Towne, RN, BSN, MHANurse Consultant Division of Diabetes Treatment and Prevention (Originally presented on 08/17/22.) |
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New Helping Your Patients with Diabetes Slow the Progression of Diabetic Kidney Disease in T2D; Part 1 – Screening, Diagnosis & Monitoring Exit Disclaimer: You Are Leaving www.ihs.gov
Carol Greenlee MD MACPWestern Slope Endocrinology (Originally presented on 08/03/22.) |
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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.) |
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| 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.) |
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| 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 Medical Director Maternal Child Health Services Alaska Native Medical Center (Originally presented on 11/09/21.) |
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| 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.) |
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