Feasibility of implementing DPP on a large scale is still unclear. The YMCA and Omada Health studies document the success of community-based DPP programs once people are enrolled. However, attracting individuals to the DPP and similar lifestyle change interventions remains a significant challenge. The scalability of both in-person and online programs is also less certain, particularly in the context of a large health care system hoping to offer Medicare DPP to potentially tens of thousands of patients. Reach in the YMCA demonstration project appeared quite high (82.9%); however, this was calculated as the number of participants attending four or more sessions divided by the number of participants who attended at least one session. Therefore, only the total number of individuals initially engaged was accounted for and not the total number at risk for diabetes in the population. Although effective and possibly easy to scale up, the reach of an online DPP program in an older adult population is also unknown. Since there was no randomization in the demonstration projects, there is potential bias in the weight outcomes and retention rates reported. Furthermore, participant motivation for enrolling or continuing participation was not assessed in the previous projects and the proposed payment model for Medicare DPP has not been vetted by health care systems, both of which could have significant implications for the expansion and sustainability of Medicare DPP.