More than 86 million people, including 22 million people 65 or older, have pre-diabetes, which increases their risk of heart disease, strokes or diabetes. As we’ve watched that number grow, it has somehow felt that despite billions of dollars of research and intervention, there’s little we can do.
That feeling shifted last week when Sylvia Mathews Burwell, the secretary of health and human services, announced that Medicare was planning to pay for lifestyle interventions focusing on diet and physical activity to prevent Type 2 diabetes. It’s an example of small-scale research efforts into health services that have worked and that have expanded to reach more people.
Articles appear every day on “major breakthroughs,” which later never pan out, while this one, full of successes, rarely made the news. This is the curse of health services research, which seeks to improve population health through improvements in access or delivery of care. When most people think of diabetes research, they’re thinking about a cure or a new medication. Those grand slams are exciting, but they rarely happen. Nevertheless, people want to see them. Donors want to support them. Organizations hire people to go after them.
Health services research is more about hitting singles, day after day. There’s no billion dollar payoff, no fame, no Nobel Prize. But it gets the job done, and it’s often more likely to change the health of most Americans.
This announcement is based on work at an Indianapolis Y.M.C.A. by a social ecologist named David Marrero, who works with me at the Indiana University School of Medicine. The other collaborator, a physician named Ron Ackermann, once shared a cubicle with me when we were both fellows, and also did much of this work at Indiana University.
The Diabetes Prevention Program grew out of extensive research on weight management and behavioral learning. More than 3,200 patients ages 25 to 75 with pre-diabetes were randomized to one of three groups. The first group was given an intensive lifestyle intervention. By focusing on a low-fat, low-calorie diet with the addition of exercise through brisk walking or a similar intensity activity, it encouraged people to lose at least 7 percent of their body weight and maintain that over the course of the trial.
The backbone of the intervention involved 16 one-hour face-to-face meetings that helped each individual participant set and achieve goals to improve health habits. The second group was treated with metformin, a medication that can lower blood glucose, and the third was the control group, provided with a placebo medication.
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