A Randomized Comparative Effectiveness Trial for Preventing Type 2 Diabetes
A Randomized Comparative Effectiveness Trial for Preventing Type 2 Diabetes
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DOI：
10.2105/ajph.2015.302641
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发表时间：
2015-11-01
影响因子：
12.7
通讯作者：
Saha, Chandan
中科院分区：
文献类型：
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作者：
Ackermann, Ronald T.;Liss, David T.;Saha, Chandan
目标。我们评估了用于糖尿病预防计划(DPP)生活方式干预的基督教青年会模式的减肥效果。在2008年7月至2010年11月期间，我们在印第安纳州印第安纳波利斯随机选择了509名超重或肥胖、低收入、非糖尿病、血糖升高的成年人，接受标准护理和简短的生活方式咨询，或者接受基于小组的基督教青年会DPP(YDPP)的适应。主要结果是12个月时的平均体重减轻差异。在我们的意向处理分析中，我们使用了纵向线性回归或Logistic回归，多次归因于缺失的观察。我们使用工具变量回归来评估完成9次或9次以上干预课程的参与者的减肥效果。在YDPP ARM，161人(62.6%)参加了1节课，103人(40.0%)完成了9节或9节以上的课程。在意向治疗分析中，YDPP组的12个月平均体重减轻比标准护理组多2.3公斤(95%可信区间[CI]=1.1，3.4公斤)。在工具变量分析中，参加9次或更多课程的人比只参加标准护理的人体重减轻5.3公斤(95%CI=2.8，7.9公斤)。YMCA模式的DPP交付在低收入成年人中实现了12个月的有意义的体重减轻。
Objectives. We evaluated the weight loss effectiveness of a YMCA model for the Diabetes Prevention Program (DPP) lifestyle intervention.Methods. Between July 2008 and November 2010, we individually randomized 509 overweight or obese, low-income, nondiabetic adults with elevated blood glucose in Indianapolis, Indiana, to receive standard care plus brief lifestyle counseling or be offered a group-based YMCA adaptation of the DPP (YDPP). Primary outcome was mean weight loss difference at 12 months. In our intention-to-treat analyses, we used longitudinal linear or logistic regression, multiply imputing missing observations. We used instrumental variables regression to estimate weight loss effectiveness among participants completing 9 or more intervention lessons.Results. In the YDPP arm, 161 (62.6%) participants attended >= 1 lesson and 103 (40.0%) completed 9 or more lessons. In intention-to-treat analysis, mean 12-month weight loss was 2.3 kilograms (95% confidence interval [CI] = 1.1, 3.4 kg) more for the YDPP arm than for standard care participants. In instrumental variable analyses, persons attending 9 or more lessons had a 5.3-kilogram (95% CI = 2.8, 7.9 kg) greater weight loss than did those with standard care alone.Conclusions. The YMCA model for DPP delivery achieves meaningful weight loss at 12 months among low-income adults.