Translating the Diabetes Prevention Program Lifestyle Intervention to the Military Setting.
Translating the Diabetes Prevention Program Lifestyle Intervention to the Military Setting.
复制标题
将糖尿病预防计划生活方式干预转化为军事环境。
DOI：
10.1093/milmed/usac037
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发表时间：
2023
影响因子：
1.2
通讯作者：
Kriska,AndreaM
中科院分区：
文献类型：
--
作者：
Kramer,MKaye;Agee,SusanC;Miller,RachelG;Arena,VincentC;Vanderwood,KarlK;Eaglehouse,YvonneL;Venditti,ElizabethM;Kriska,AndreaM
糖尿病和肥胖对美国军人受益人群构成了重大负担，因此需要为军人、退休人员及其家属提供基于证据的糖尿病和肥胖预防服务。尽管糖尿病预防计划（DPP）生活方式干预在全国范围内的传播越来越广泛，但对这一非常成功的计划实施的正式评估在军事环境中是有限的。本研究的目的是前瞻性评估在美国空军医疗机构Wright-Patterson医疗中心（WPMC）实施的1年直接适应DPP生活方式干预的可行性，以确定该计划在一组有风险的现役军人、退休人员和家庭成员中实施的可行性，并评估改善体重和其他2型糖尿病风险因素的有效性。材料和方法采用前后研究设计来评估DPP群体生活方式平衡（GLB）的可行性和有效性，GLB是WPMC最新的22期DPP课程的直接改编。参与者选择通过教练带领的面对面小组或通过DVD完成为期一年的课程，每周与教练进行电话联系。这项研究得到了匹兹堡大学和WPMC机构审查委员会的批准。结果共有99人入组，其中83人（84%）和77人（78%）分别完成了6个月和12个月的随访评估。基线时参与者的平均年龄为57岁（20-85岁），其中63%为女性。该组由非西班牙裔白人（73.7%）、非西班牙裔黑人（18.2%）和其他种族或西班牙裔（8.1%）组成。其中，现役军人10人，退休人员37人，家属52人。DPP-GLB项目被证明是可行的，可以在这个军事医疗环境中实施，因为在为期一年的项目过程中，参与者的参与度很高。两项主要行为目标均有显著改善：平均体重(- 12.8磅，- 6.3%，P<。平均体力活动（PA） （+18.9 Met-hrs/周，P< 0.001）。此外，其他糖尿病和心血管危险因素的显著改善，包括低密度脂蛋白胆固醇、空腹胰岛素、舒张压和腰围，以及与健康相关的生活质量的改善。结论DPP-GLB方案在改善现役和退役军人及其家属的体重、PA水平、糖尿病和心血管危险因素方面是可行和有效的。该项目得到了项目参与者和WPMC团队的一致好评。这些发现为在整个军事卫生系统中提供DPP-GLB计划提供了一个模型。
IntroductionDiabetes and obesity pose a significant burden for the U.S. military beneficiary population, creating a great need to provide evidence-based diabetes and obesity prevention services for military personnel, retirees, and their dependents. Despite increasing dissemination of the Diabetes Prevention Program (DPP) lifestyle intervention nationwide, formal evaluation of implementation of this highly successful program is limited in the military setting. The purpose of this study is to prospectively evaluate delivery of a direct adaptation of a 1-year DPP lifestyle intervention at a U.S. Air Force medical facility, Wright-Patterson Medical Center (WPMC), to determine the feasibility of delivery of the program in a group of at-risk active duty military, retirees, and family members, as well as assess effectiveness in improving weight and other risk factors for type 2 diabetes.Materials and MethodsA pre/post study design was utilized to evaluate feasibility and effectiveness of the DPP Group Lifestyle Balance (GLB), an up-to-date, 22-session direct adaptation of the DPP curriculum, at WPMC. Participants chose to complete the 1-year program either in coach-led face-to-face groups or via DVD with weekly telephonic coach contact. The study was approved by the University of Pittsburgh and WPMC Institutional Review Boards.ResultsA total of 99 individuals enrolled in the study, with 83 (84%) and 77 (78%) completing 6- and 12-month follow-up assessments, respectively. The mean age of participants at baseline was 57 (range 20-85 years), with 63% being female. The group was comprised of individuals who were non-Hispanic White (73.7%), non-Hispanic Black (18.2%), and other race or Hispanic ethnicity (8.1%). Within this group, there were 10 active duty military, 37 retirees, and 52 family members. The DPP-GLB program was shown to be feasible to implement in this military healthcare setting as demonstrated by the high engagement over the course of the year-long program. Significant improvements were shown in the two main behavioral goals: mean weight (−12.8 lbs, −6.3%,P< .001) and mean physical activity (PA) (+18.9 Met-hrs/wk,P< .001). In addition, significant improvements in other diabetes and cardiovascular risk factors including low-density lipoprotein cholesterol, fasting insulin, diastolic blood pressure, and waist circumference were noted, as well as improvement in health-related quality of life.ConclusionsThese results demonstrate that the DPP-GLB program delivered via face-to-face groups or DVD was feasible and effective in improving weight, PA levels, and diabetes and cardiovascular risk factors in this group of active and retired military personnel and their family members. The program was well received by the program participants as well as the WPMC team. These findings offer a model for provision of the DPP-GLB program throughout the Military Health System.