Translating the Diabetes Prevention Program Lifestyle Intervention for Weight Loss Into Primary Care A Randomized Trial
Translating the Diabetes Prevention Program Lifestyle Intervention for Weight Loss Into Primary Care A Randomized Trial
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DOI：
10.1001/2013.jamainternmed.987
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发表时间：
2013-01-28
影响因子：
39
通讯作者：
Stafford, Randall S.
中科院分区：
文献类型：
--
作者：
Ma, Jun;Yank, Veronica;Stafford, Randall S.
背景：糖尿病预防计划(DPP)的生活方式干预将高危成年人中2型糖尿病(DM)的发病率降低了58%，体重减轻是主要预测因素。方法：我们对从1家初级保健诊所招募的患有糖尿病前期和/或代谢综合征的超重或肥胖成年人进行了2种适应的DPP生活方式干预。参与者被随机分为(1)教练领导的小组干预(n=79)，(2)自我指导的DVD干预(n=81)，或(3)常规护理(n=81)。在为期3个月的强化干预阶段，基于DPP的行为减肥课程由生活方式教练领导的小组或基于家庭的DVD提供。在维护阶段，两种干预措施的参与者都接受了远程生活方式改变的指导和支持-通过电子健康记录系统内的安全电子邮件和美国心脏协会心脏360网站，以设定体重和体力活动目标并进行自我监测。主要结果是体重指数(BMI)(体重用公斤除以身高的平方)从基线到15个月的变化。结果：基线时，参与者的平均年龄(SD)为52.9(10.6)岁，平均BMI为32.0(5.4)；47%为女性；78%为非西班牙裔白人；17%为亚洲/太平洋岛民。15个月时，训练组BMI较基线的平均+/-SE变化为-2.2+/-0.3，而常规护理组为-0.9+/-0.3(P
Background: The Diabetes Prevention Program (DPP) lifestyle intervention reduced the incidence of type 2 diabetes mellitus (DM) among high-risk adults by 58%, with weight loss as the dominant predictor. However, it has not been adequately translated into primary care.Methods: We evaluated 2 adapted DPP lifestyle interventions among overweight or obese adults who were recruited from 1 primary care clinic and had pre-DM and/or metabolic syndrome. Participants were randomized to (1) a coach-led group intervention (n=79), (2) a self-directed DVD intervention (n=81), or (3) usual care (n=81). During a 3-month intensive intervention phase, the DPP-based behavioral weight-loss curriculum was delivered by lifestyle coach-led small groups or home-based DVD. During the maintenance phase, participants in both interventions received lifestyle change coaching and support remotely-through secure email within an electronic health record system and the American Heart Association Heart360 website for weight and physical activity goal setting and self-monitoring. The primary outcome was change in body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) from baseline to 15 months.Results: At baseline, participants had a mean (SD) age of 52.9 (10.6) years and a mean BMI of 32.0 (5.4); 47% were female; 78%, non-Hispanic white; and 17%, Asian/Pacific Islander. At month 15, the mean +/- SE change in BMI from baseline was -2.2 +/- 0.3 in the coach-led group vs -0.9 +/- 0.3 in the usual care group (P