Subphenotyping And Strengthening The ROI For The National Diabetes Prevention Program

Enrolling only the subset of individuals with prediabetes who are most likely to progress to Type 2 could strengthen the case for covering the National DPP.  The publication of the Wagner, et al study in Nature Magazine portends potential changes in the treatment of prediabetes, as well as the return-on-investment story for the National Diabetes Prevention Program lifestyle change program.

Wagner and his colleagues developed six pathophysiology-based clusters to denote differences between individuals who heretofore were all labeled with the same diagnosis: prediabetes.

Not all individuals with prediabetes progress to Type 2 diabetes, but some do.  Knowing how to distinguish between those at higher and lower risk has been elusive, but the Wagner study offers hope for drawing that distinction.  In the study, clusters 3 and 5 (of a total of 6) are at high or “imminent” risk of progressing to Type 2 diabetes.  This sort of typing may become a boon for health plan and employer sponsors of the National Diabetes Prevention Program.  Right now health plans and employers that weigh the option of sponsoring the National Diabetes Prevention Program face a sobering return-on-investment story.  It may take two or more years to recoup the investment on the year-long program.

While an impressive number of plans and employers make the lifestyle change program available to individuals with prediabetes, some – particularly those who see high employee or beneficiary turnover – continue to hang back.

If health plans and employers can elect to offer the program to only the individuals most likely to progress to Type 2 diabetes – such as the individuals in clusters 3 and 5 – it is possible that a strong return-on-investment will follow.  They will be putting dollars on the table for individuals at high risk – and likely avoiding the costs of downstream diabetes care.

Right now vendors and community based organizations that offer the National Diabetes Prevention Program go to great lengths to enroll eligible individuals who are committed to staying in the year-long program, and to retain them in the program once they start.  Effectively filtering for individuals who are most likely to progress to Type 2 in the absence of an intervention may be another lever for delivering stronger return-on-investment to the health plan and employer sponsors who foot the bill.

Implementing this “filter” could result in less revenue per account for vendors in this space, but more accounts and better stickiness – especially for vendor front runners who can offer a stronger value proposition and entice employers and plans who are hanging back.

It will be heartening when covering the intervention makes financial sense for all plan sponsors, and the subphenotyping of individuals with prediabetes as put forward by Wagner and team may be a step along that path.