>> Yes, the Diabetes Prevention Program,
so it is based on the original Diabetes Prevention Program
clinical trial, who's main results were published in 2002.
Basically, since then, there's been accumulating evidence,
that we can do the DPP intervention
from the research study, in the real world.
And in 2015, when The Brancati Center
was really founded, we decided that we would focus
on diabetes prevention, based on the evidence base,
and also based on the idea that reimbursement
and health policy were supporting the program.
We have expertise in that, but in addition,
so we went out to the community
and tried to see what they were interested in,
and diabetes, of chronic diseases,
really important condition.
East Baltimore, or Baltimore City
generally has very high rates of diabetes,
mortality related to diabetes,
and complications related to diabetes,
such as blindness, amputation
and the need for dialysis, kidney failure.
So we work with community partners,
in mainly around John Hopkins Hospital,
some of our most enduring partners
are churches in the area, and basically,
we collaborate to do the DPP.
We look for collaborators, or community partners
who are interested in health, obviously,
who are interested in establishing a high quality program,
collaboratively, but also interested
in doing the program long term,
so we are not really establishing programs
that would just go away after one year.
So for a given program, the way it works is,
from The Brancati Center, you know,
we have expertise in the actual intervention,
we have coaches, and those coaches will work with coaches
that we train from the community partner as well,
and together they'll lead the classes
and conduct the sessions,
follow up with participants between sessions.
We provide all of the data management and analysis
and then, the community partner, will work with us
to figure out if we're having trouble with retention,
or outcomes, kind of how to trouble-shoot
and how to keep people engaged.
The first year that INHS started collecting data
on whether or not people are getting
referred to the DPP, we did the analysis.
And so the analysis really is about people
who knew they had pre-diabetes,
which is a small segment of the population
with pre-diabetes, and of those who actually reported
having gotten referred or actually participated
in a program, and yeah, you're right,
the rates were extremely low, way less than ten per cent,
for each of those, and we think that
there were probably a few reasons for that.
We've done some work, that we've published on
doing surveys of primary care providers,
I think that the awareness of pre-diabetes is really low,
so people aren't getting caught,
you can see that if you look at the CDC numbers,
about 11% of people are unaware that they have pre-diabetes,
of those people who actually have it.
We think 84 million people probably meet criterium.
And then, in addition, our surveys have shown,
that primary care providers are just
unaware of what to do for diabetes prevention.
Some of that may not be a lack of awareness,
some of it may be a lack of awareness
of lack of resources, so a lot of providers
that we've gotten responses from,
also say that they think that there's, you know,
one of the barriers to diabetes prevention,
is actually the existence of programs,
so, lack of program capacity.
So I think that it's probably multi-factorial,
lack of provider awareness, or referral,
lack of actual programs to be referred to,
as a primary care provider, I'm not going to refer someone
to a program that doesn't exist.
And so, if I'm unaware of a program in our neighborhood
or our community, I'm not gonna refer to it.
And then I think also, patients have to know about it.
So you should find out if you're
at risk for diabetes and then if you are,
figure out if you can be referred, or if you can self-refer,
to a diabetes prevention program that's convenient for you.
Providers need to screen people for diabetes,
and they'll identify people with pre-diabetes,
they need to be aware that there are
diabetes prevention programs,
more and more are coming on line,
high quality ones are coming online every day.
And that's something that they have to be mindful of
I think from a provider standpoint, it's hard,
because I said right now, there's still low capacity,
there are 84 million people
that probably meet criteria for this,
and 15 or 1,600 programs in the country that are operating.
However, you can see from the study we did,
that very few people are getting referred,
so we need to increase that.
If we increase referrals,
that's an overall increase in demand that can also
cultivate, you know, increase capacity.