Launch Your Own Diabetes Prevention Program

Drug Topics Journal, Drug Topics November 2021, Volume 165, Issue 11


The CDC estimates that 83 million Americans have prediabetes and that 84% of them don’t know it and community pharmacy can play a major role in preventing diabetes.

The flooding tide of individuals with elevated blood glucose levels is a daunting challenge and an alluring opportunity. The CDC estimates that 83 million Americans, more than 1 in 3, have prediabetes and that 84% of them don’t know it. The CDC also knows that community pharmacy can play a major role

in preventing and delaying progression to diabetes. The concept grew from The Asheville Project, a pharmacy-based, chronic-disease treatment and prevention program launched by the city of Asheville in North Carolina in 1997.

The numbers are compelling. For individuals with prediabetes, losing 5% to 7% of initial body weight and increasing physical activity to 150 minutes per week can reduce the risk of developing type 2 diabetes by 58% (71% for people older than 60 years).1

“We were doing diabetes prevention through lifestyle modification. We just didn’t know to call it that 25 years ago,” said Barry Bunting, PharmD, who helped launch and manage The Asheville Project. He now manages the American Pharmacists Association (APhA) Diabetes Prevention Program (DPP) funded by the CDC.

“We were educating people on their risk of progressing to diabetes, giving a lot of personal coaching on eating a little better, moving a little more, and losing a few pounds,” Bunting said. “That is the same script the CDC uses in its lifestyle-change DPP.”

DPP Elements

The CDC has partnered with APhA, the National Community Pharmacists Association (NCPA), and other pharmacy groups to extend the reach of its DPP to the local level. The CDC is also working with state and local health departments, Medicaid, and advocacy groups such as the Association of Diabetes Care & Education Specialists (ADCES) to involve pharmacists in expanding access to diabetes prevention services through early intervention.

“I am a huge pharmacy fan,” said Angela Forfi a, ADCES senior manager of prevention. “And not just because pharmacies have been in diabetes prevention since the very beginning. It’s all about access to pharmacies, pharmacists’ training, and the reality that people with prediabetes are overrepresented in pharmacy patient

populations. Pharmacists know that lifestyle intervention is twice as effective as off-label metformin at reducing the risk of progressing from prediabetes to type 2 diabetes.”

Dozens of pharmacies, primarily independents and some grocery store outlets, have launched DPPs.

“This is the direction we are headed,” said Benjamin McNabb, PharmD, owner of Love Oak Pharmacy in Eastland, Texas. “I call it the community wellness model. The approach is managing diseases in the community before they get to the point where you need medication and other interventions. It’s about providing information, providing care at the personal level to keep potential problems from escalating. And it’s one more service you can eventually get paid for.”

A DPP has 3 tiers. Tier 1 is promoting awareness of prediabetes. Pharmacy engagement can be as simple as bag stuffers and countertop displays, quick conversations with patients who could be at risk, and social media messages.

“Social media, patient emails, and flyers in the store have been fantastic for us,” said Amber Suthers, MSAH, CPhT, clinical services coordinator at Surgoinsville Pharmacy in Tennessee. The pharmacy was part of NCPA’s first DPP cohort.

“And prediabetes is an obvious conversation when a patient comes in to pick up meds for blood pressure and cholesterol,” Suthers added, “especially if they seem on the heavy side, like so many are. People don’t always recognize their potential for diabetes.”

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