Tier 2: Screen, Test, Refer, and Enroll Patients

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To meet the eligibility requirements for the National DPP Lifestyle Change Program (LCP), participants must have prediabetes or be at high risk of developing type 2 diabetes. Pharmacists can help determine eligibility by screening patients using a CDC-approved Prediabetes Risk Test, administering a blood glucose test, or referring patients to their primary care provider for a blood glucose test. They can then refer or enroll eligible patients in an LCP delivered by a CDC-recognized organization.

Screen

Tips for Screening Patients

  • Use waiting time to administer the paper risk test.
  • Consider giving the test verbally instead of giving patients a paper copy to fill out. This approach may help establish a connection with patients and make it easier to personalize your recommendations. The risk test typically takes about 1 minute to complete.
  • It’s better for participants to enroll in the National DPP on the basis of blood glucose test results. You should encourage a blood glucose test for any patient who scores high on the risk test.
  • All adults can take the prediabetes risk test. Encourage patients who are overweight, take medications, or have health conditions that may put them at higher risk of prediabetes to take the test.
  • Administer a blood glucose test to all patients who score high on the risk test or refer them to a health care provider for blood glucose testing.

Screening for prediabetes is the first step that pharmacists can take to determine if the National DPP LCP is appropriate for their patients. All pharmacists can add these screening tests to their workflows to start conversations with patients about risk factors and recommended next steps.

The American Diabetes Association (ADA)/CDC prediabetes risk test can be completed online at  Prediabetes Risk Test or printed [PDF – 247 KB] and filled out by hand.

Test

A blood glucose test is another way to determine if a patient is at risk of developing type 2 diabetes. If you cannot offer a blood glucose test, refer patients with a high score on the paper or online risk test to a clinical partner or primary care provider for confirmatory blood glucose testing. Table 1 provides information about the tests used to identify prediabetes and the follow-up actions recommended depending on the results.

Table 1. Blood Glucose Tests Used to Identify Prediabetes and Recommended Follow-Up
Results HbA1C Test Fasting Plasma Glucose Test Plasma Glucose Test 2 Hours After a 75 gm Glucose Load Follow-Up Action
Normal <5.7% <100 mg/dL <140 mg/dL Encourage patient to maintain a healthy lifestyle.
Prediabetes 5.7%–6.4% 100–125 mg/dL* 140–199 mg/dL Refer patient to a primary care provider and an LCP delivered by a CDC-recognized organization.
Diabetes ≥6.5% ≥126 mg/dL ≥200 mg/dL Refer patient to a primary care provider for confirmatory diagnosis, diabetes self-management education and support, and treatment if appropriate.

*The fasting plasma glucose requirement for Medicare Diabetes Prevention Program suppliers is 110–125 mg/dL.

Refer

Program Costs

If you refer a patient to a program, they may ask about the cost. There is no fixed cost for the National DPP LCP. Costs depend on the organization offering the program. Some programs are free, while others charge a fee. Some employers and insurance carriers offer the program as a covered health or wellness benefit.

You can recommend that your patients contact their employer or insurance provider to find out if they cover this type of program.

When you screen patients with the prediabetes risk test and administer blood glucose testing, you will likely identify patients with prediabetes. Use this opportunity to apply elements of motivational interviewing, goal setting, problem solving, and cultural sensitivity to guide patients toward enrollment in the LCP. In some cases, you may uncover new cases of diabetes. When this occurs, refer patients to a primary care provider for a confirmatory diagnosis and diabetes self-management education and support services.

When patients are found to be at high risk of developing type 2 diabetes because of their risk test score or an elevated blood glucose level in the prediabetes range, refer them to both of the following:

  • Primary care provider
    Tell the patient’s primary care provider about screening or blood glucose test results so the diagnosis can be confirmed, documented, and managed. Refer patients to a nearby primary care provider if they do not already have one.
  • Lifestyle change program
    Establish relationships with one or more LCPs nearby or online. Take time to understand their processes and policies so you can refer eligible patients to a program. To find an LCP near you or one delivered virtually, go to the National DPP’s Find a Program website.

Enroll

Who Is Eligible to Enroll in the National DPP Lifestyle Change Program?

CDC-recognized organizations can accept referrals based on the results of a risk test alone. However, eligibility may vary according to the individual program or the policies of the payers. If the organization is a Medicare Diabetes Prevention Program (MDPP) supplier, the Centers for Medicare & Medicaid Services (CMS) requires blood glucose testing. Participant eligibility and enrollment requirements for MDPP suppliers are noted throughout this section. For more information about MDPP, visit the MDPP Expanded Model website. See a Tier 2 case study.

Table 2. Criteria for Enrollment in the National Diabetes Prevention Program Lifestyle Change Program
ALL PARTICIPANTS MUST:
  • Be at least 18 years old.
    AND
  • Not be pregnant at the time of enrollment.
    AND
  • Be overweight, with a body mass index ≥25kg/m2 (≥23kg/m2 if an Asian person).
    AND
  • Not have a previous diagnosis of type 1 or type 2 diabetes before enrollment.
A MINIMUM OF 35% OF LCP PARTICIPANTS MUST:
  • Have a blood glucose test result in the prediabetes range within the past year or a claim code indicating that they have prediabetes according to one of the following measures:
    • HbA1C of 5.7% to 6.4% or
    • Fasting plasma glucose of 100 to 125 mg/dL (Note: CMS eligibility requirement for MDPP participants is 110 to 125 mg/dL.) or
    • Plasma glucose of 140 to 199 mg/dL measured 2 hours after a 75 gm glucose load.
      OR
  • Have been clinically diagnosed with gestational diabetes mellitus during a previous pregnancy (may be self-reported). (Note: A previous history of gestational diabetes is not included in the MDPP eligibility criteria.)
A MAXIMUM OF 65% OF LCP PARTICIPANTS MAY:
TO BE ENROLLED IN THE MDPP:
  • Participants cannot self-report blood test results. Lab results must be provided. Blood test results must meet one of the following specifications:
    • Fasting plasma glucose of 110 to 125 mg/dL or
    • Plasma glucose of 140 to 199 mg/dL measured 2 hours after a 75 gm glucose load or
    • HbA1C of 5.7% to 6.4%. 

Abbreviations: CMS = Centers for Medicare & Medicaid Services; MDPP = Medicare Diabetes Prevention Program.

Case Study

American Pharmacists Association Foundation and National Community Pharmacy Association Support the National DPP Lifestyle Change Program

From 2017 to 2022, the American Pharmacists Association Foundation (APhA Foundation) worked with community pharmacies to reach communities with limited resources as part of a 5-year cooperative agreement with CDC. In the spring of 2022, the foundation partnered with the National Community Pharmacy Association (NCPA) to pilot the expansion of this community pharmacy model, called the STARS (Screen, Test, and Referral Solutions) program.

The pilot program is using a pay-for-performance approach to determine the effectiveness of providing financial incentives for pharmacies to screen, test, refer, and enroll participants in the National DPP LCP. Pharmacies are not required to offer the LCP themselves. Instead, they screen and refer people who are eligible to a distance-learning program. This approach recognizes that some pharmacies may not have the time or expertise to offer classes, but they can help identify people at risk of developing type 2 diabetes.

The STARS program also recognizes there are often more National DPP LCP classes (especially through distance learning) available than there are people who want to enroll. Previous experience has shown that only 1 in 10 people who are identified as eligible actually follow through and enroll in the National DPP LCP and attend classes. The STARS program addressed this problem by working to screen large groups of people, as a way to increase enrollment.

Tier 2 in Action: Screen, Test, Refer, and Enroll Patients

Chronic diseases, including diabetes, affect many people across the United States. Community pharmacies are an ideal and trusted point of care for many patients who need help addressing their health care needs. Community pharmacy staff are also knowledgeable and experienced in screening and referring people at risk for type 2 diabetes to the services they need.

Since the spring of 2022 of the STARS program, the APhA Foundation and NCPA have successfully contracted with 25 community pharmacies in 11 states and have enrolled a combined 300 participants in the National DPP LCP.

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Pharmacy Guide Pages

  1. Why Should You Participate?
  2. Tier 1: Promote Awareness of Prediabetes and the National DPP Among Patients at Risk
  3. ›Tier 2: Screen, Test, Refer, and Enroll Patients
  4. Tier 3: Offer the National DPP Lifestyle Change Program
  5. How to Sustain Your Program