New Medicare Perk: Diabetes Prevention
Millions of U.S. seniors can now take part in a Medicare program designed to prevent prediabetes from progressing to type 2 diabetes.
Almost half of Americans 65 and older have prediabetes, and many don't know it. In addition to an increased risk of type 2 diabetes, prediabetes puts people at risk of heart disease and stroke, according to the American Association of Diabetes Educators.
"Medicare has expanded its coverage to include diabetes prevention, and that's really great news," said Angela Forfia, senior manager of prevention for the American Association of Diabetes Educators.
Prediabetes means blood sugar levels are elevated, but not as high as in type 2 diabetes. Weight loss and increased physical activity can help ward off a type 2 diagnosis.
"Seniors are a very high-risk group for type 2 diabetes," Forfia said. But they're also much more likely than younger people to be successful at preventing diabetes, she added.
Taking action is key. "If you wait even a year, prediabetes can become diabetes," Forfia said.
The Medicare Diabetes Prevention Program is based on a year-long national diabetes prevention program started by the U.S. Centers for Disease Control and Prevention.
Private insurers often cover the CDC's diabetes prevention program because it's been shown to reduce the risk of type 2 diabetes by 58 percent overall. In people over 60, the program reduces risk of type 2 diabetes by 71 percent, according to the diabetes educators' group.
The new program includes at least 16 intensive "core" sessions of a CDC-approved curriculum. Those 16 sessions occur over six months in a classroom-style setting. Participants receive education on long-term dietary changes, increased physical activity, and behavior-change strategies for weight control, according to the U.S. Centers for Medicare and Medicaid Services.
After the core sessions are done, less intensive follow-up meetings are held monthly to help reinforce the new healthy behaviors.
The main program goal is to lose at least 5 percent of body weight. The program also aims to get people exercising at least 150 minutes a week, Forfia added.
But program coordinators work with program participants to "set realistic, achievable goals," Forfia said.
Overall, the program includes 24 hours of instruction. "It's really just a full day of commitment, and the program can have a tremendous impact on your life," she noted.
This is welcome news, said Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City.
"Treating prediabetes is better than treating diabetes. The CDC's diabetes prevention program has been very successful, but we don't always have enough referrals to the program," Zonszein said.
"Primary care physicians need to know this is a tremendous opportunity to help their patients with prediabetes," he added.
So, who's eligible for the new program? First, you must be enrolled in Medicare Part B. Other requirements include:
- A body mass index (BMI) of at least 25, or at least 23 if Asian. (BMI is a rough measure of body fat using height and weight measurements. A BMI of 25 or higher is considered overweight.)
- An abnormal blood sugar level within 12 months of the first core session. Blood sugar can be measured in one of three ways: An A1C test that doesn't have to be done fasting (5.7 to 6.4 percent is prediabetes); a fasting blood test (110 to 125 milligrams per deciliter is prediabetes); or a 2-hour fasting glucose tolerance test (140 to 199 mg/dL is prediabetes).
- No previous diagnosis of type 1 or type 2 diabetes.
- No end-stage kidney disease.
Although the reimbursement for services became available in April, Forfia said it will likely take programs time to get started. In the meantime, she said the CDC's diabetes prevention program may offer classes in your area. Talk with your doctor to see if you need diabetes prevention services. Your physician may also be able to help you enroll.
Learn more about the Medicare Diabetes Prevention Program from the U.S. Centers for Medicare and Medicaid Services.
SOURCES: Angela Forfia, M.A., senior manager, prevention, American Association of Diabetes Educators, Chicago; Joel Zonszein, M.D., director, Clinical Diabetes Center, New York City