Provider Resources

To participate, patients must: 

• Be at least 18 years old.
• Be overweight with a BMI of 24 or greater; 23 or greater if Asian.
• Not diagnosed with type 1 or type 2 diabetes.
• Not currently pregnant.

And meet one of the following criteria:

• Have established risk factors for developing type 2 diabetes based on risk test.
• Have been diagnosed with prediabetes within the past year.
• Have been previously diagnosed with gestational diabetes.

The National DPP can improve patients’ overall health by helping them lose weight, eat healthier, and be more active. The National DPP is based on the Diabetes Prevention Program research study (2002), led by the National Institutes of Health (NIH) and supported by the Centers for Disease Control and Prevention (CDC), which showed that lifestyle change was nearly twice as effective (58% vs 31%) as taking prescription medicines in reducing the risk of type 2 diabetes among people with prediabetes.

This research has shown that weight loss of 5-7% achieved by making healthier food choices and achieving 150 minutes of physical activity each week reduced the risk of type 2 diabetes by 58% in people at high risk for disease, and up to 71% among people aged 60 and older.

Find a National DPP in your area, contact the program, and build a referral relationship to refer your patients who are at risk for type 2 diabetes.

The American Medical Association (AMA) provides tools for physicians to prevent type 2 diabetes in their patient population. The M.A.P. framework was developed by the AMA and focuses on three approaches to addressing challenges in diagnosing and treating chronic disease. These approaches are:

1. Measure accurately
2. Act rapidly
3. Partner with patients

Visit the Health Tools website to order free prediabetes materials for your clinic. Relevant prediabetes materials include: 

• Know Your Score Brochure  
• Prediabetes Fact Sheet 
• National DPP Fact Sheet  

The USPSTF recommends screening for prediabetes and type 2 diabetes in adults aged 35 to 70 years who have a diagnosis of overweight or obesity.

Visit the USPSTF website for additional information on screening for prediabetes and type 2 diabetes.

The USPSTF recommends screening for gestational diabetes in asymptomatic pregnant persons at 24 weeks of gestation or after.

Visit the USPSTF website for additional information on gestational diabetes screening.

The Association of Diabetes Care & Education Specialists (ADCES), formally known as the American Association of Diabetes Educators, American Diabetes Association (ADA), and Academy of Nutrition and Dietetics issued an algorithm and guidance to healthcare practitioners on when to refer patients to diabetes educators and others. 

Referrals should be considered at initial diagnosis.

Providers should consider referring patients under the following circumstances:

1. Poorly controlled diabetes.
2. Have questions about healthy lifestyle behaviors as it relates to their diabetes.
3. If there have been significant changes to treatment or a new condition that affects their diabetes (i.e., diagnosis of a new health condition, changes to medication, or stressful life events).

ADCES and ADA also developed a backgrounder and education fact sheet that includes a summary of Medicare MNT benefit requirements and DSME/T requirements, as well as examples of how MNT and the DSME/T services can be coordinated for qualifying Medicare beneficiaries.

The Centers for Medicare & Medicaid Services (CMS) uses the term training instead of education. DSMES is also known as Diabetes Self-Management Education/Training Services (DSME/T) when defining the reimbursable benefit. DSME/T and MNT benefits are significantly underutilized by Medicare beneficiaries. Data from Medicare Quality Improvement Organizations reveals the root causes of this underutilization are clinicians' limited awareness/confusion of the benefits and how to order the benefits for a patient.

In response, the ADCES and ADA joined forces to develop the Diabetes Services Order Form, which is designed to be an easy and convenient way for a physician or a qualified non-physician practitioner to refer their Medicare patients with diabetes to a diabetes educator for DSME/T and a registered dietitian for MNT.

The standardized referral form can be used by any facility or healthcare professional and includes the key referral information required to meet Medicare regulatory requirements for MNT and/or DSME/T referrals, but the form itself is not required by Medicare.

October 1, 2015, marked the switch from ICD-9 codes to ICD-10 codes. The new set of codes is greatly expanded from the previous version, allowing for more specificity in diagnoses. For additional information about the codes, CMS provides detailed information.

Annually, the ADA updates the standards of medical care in diabetes. The standards of care is available in an app format, intended to help clinicians, patients, researchers, policymakers, and other healthcare professionals navigate the different aspects of diabetes care, general treatment goals, and tools to assess the quality of care. The topics covered include:

1. Improving care and promoting health in populations
2. Classification and diagnosis of diabetes
3. Prevention or delay of type 2 diabetes and associated comorbidities
4. Comprehensive medical evaluation and assessment of comorbidities
5. Facilitating positive health behaviors and well-being to improve health outcomes
6. Glycemic targets
7. Diabetes technology
8. Obesity and weight management for the prevention and treatment of type 2 diabetes
9. Pharmacologic approaches to glycemic treatment
10. Cardiovascular disease and risk management
11. Chronic kidney disease and risk management
12. Retinopathy, neuropathy, and foot care
13. Older adults
14. Children and adolescents
15. Management of diabetes in pregnancy
16. Diabetes care in the hospital
17. Diabetes advocacy

The goals of treatment for diabetes are to prevent or delay complications and optimize quality of life. View the decision cycle for patient-centered glycemic management in type 2 diabetes.

In 2018, the National Institute of Diabetes and Digestive and Kidney Disease updated its guiding principles for the care of people with or at risk for diabetes. These principles are areas of general agreement among existing guidelines to help guide healthcare providers and teams to deliver quality care. The principles include:

1. Identify people with undiagnosed diabetes and prediabetes
2. Manage prediabetes to prevent or delay the onset of type 2 diabetes
3. Provide comprehensive, patient-centered diabetes care
4. Provide ongoing self-management education and support for people with diabetes
5. Encourage lifestyle modification for people with diabetes
6. Address overweight and obesity in the management of diabetes
7. Individualize blood glucose management for people with diabetes
8. Provide multifactorial cardiovascular disease risk reduction
9. Detect and monitor diabetes microvascular complications and provide treatment to slow their progression
10. Consider the needs of special populations with diabetes

Visit the Health Tools website to order free diabetes materials for your clinic. Relevant diabetes materials include: 

• Diabetes Fact Sheet 
• DSMES Fact Sheet 
• DSMES Services: An Idaho Specific Implementation Guide 
• Diabetes & COVID-19 (Information for healthcare providers) 
• Diabetes & COVID-19 Patient Brochure 

In 2021, the USPSTF updated its Hypertension in Adults: Screening recommendation to screen all adults 18 years or older for hypertension with office blood pressure measurement. The USPSTF recommends obtaining blood pressure measurements outside of the clinical setting for diagnostic confirmation before starting treatment.

In 2023, the USPSTF released a Hypertensive Disorders of Pregnancy: Screening recommendation. The USPSTF recommends screening for hypertensive disorders in individuals who are pregnant with blood pressure measurements throughout pregnancy. 

Preference for blood pressure guideline recommendations differs between healthcare providers. Blood pressure guidelines are recommendations and are not a substitution for clinical judgment. The Joint National Committee’s eighth report in 2014 (JNC8) and the ACC/AHA 2017 guidelines are linked for reference.

Accurate BP measurement is essential for the diagnosis and management of hypertension. The BP Toolkit provides evidence-based instructions and valuable education on blood pressure measurement for clinical providers at all levels. The BP Toolkit is designed for any healthcare professional who measures blood pressure. The BP Toolkit is divided into four sequential steps:  

1. Accurate Blood Pressure Measurement for Health Professionals Video  

2. Blood Pressure Sights and Sounds Module 

3. Supplemental Provider Materials Resource 

4. Online Post-Test and a Certificate of Completion 

Strong scientific evidence supports SMBP in addition to clinical support to lower blood pressure in people with hypertension. Many goals can be achieved utilizing SMBP. For patients newly diagnosed with hypertension or patients who have difficulty adhering to medication, SMBP engages the patient to help determine medication dosage. For patients with undiagnosed hypertension, SMBP eliminates white coat syndrome to accurately diagnose hypertension. For patients who are unable to visit the office frequently, SMBP keeps patients engaged in BP management. Self-measured refers to any monitoring done outside of the clinical setting. Clinical support includes routine individual counseling, telehealth support, and educational classes. 

An Implementation Toolkit developed by the National Association of Community Health Centers provides guidance for organizations to implement SMBP.

Accurate blood pressure measurements ensure that patients are properly diagnosed and treated. U.S. Blood pressure VDL are devices that fulfill the criteria to independently validate the clinical accuracy of blood pressure measurement. Ensure your office, kiosk, and your patient's blood pressure measurement device meet the VDL criteria.

In 2020, AHA and AMA released a joint statement supporting SMBP using a VDL.

Visit the Health Tools website to order free heart disease materials for your clinic. Relevant heart disease materials include: 

• DASH to Good Health brochure
• Stroke fact sheet
• How to Check Your Blood Pressure card
• My Blood Pressure wallet card