Reducing cardiometabolic risk and promoting functional health in community-based elders with obesity and pre-diabetes: evaluating sustainable DPP follow-up strategies

点击翻译按钮获取中文摘要

ABSTRACT The confluence of obesity and pre-diabetes in older adults substantially increases the risk of diabetes, and accelerates functional decline, multimorbidity, disability, and death. More research is needed to refine and extend preventive interventions to reduce burden for elders and society. For over a decade efficacious 6- and 12-month Diabetes Prevention Program (DPP) lifestyle interventions have been translated successfully and demonstrated positive impact. However, efforts to develop and evaluate potentially scalable programs conforming to current guidelines for longer term DPP interventions (up to 24 months) and help a greater proportion of enrollees achieve and sustain the recommended weight loss target of ≥ 5% are lacking. Our scientific premise is that the evaluation of translational DPP interventions, which has centered largely on strategies for weight loss induction, must be extended to include longer-term interventions that clearly demonstrate durable weight, cardiometabolic and functional health benefits especially for vulnerable elders in community-based settings. Our previous DPP-based research has documented the utility of telephone follow- up after a 6-month DPP weight loss induction and shown that 63% of a 65-80 year old volunteer sample with obesity and other risk factors were able to sustain ≥ 5% weight loss at 12-months. Despite good evidence that longer duration lifestyle interventions yield better outcomes (reflected in the latest Medicare ruling) there are no translational studies of 24-month long DPP interventions with older adults. We now propose to utilize community based settings to examine whether we can sustain the impact of an elder-focused DPP approach using potentially scalable treatment components over a 24-month period. We will recruit and enroll 65-80 year old adults with obesity and pre-diabetes (N = 360) from a network of senior community centers that provide aging services. The intervention program sequencing will be aligned with current Medicare policy. First, from 0- 6 months, experienced lifestyle coaches will administer a DPP-video intervention anchored primarily by telephone coaching for all participants, at least 25% from ethnic/racial minority groups. Next, participants, will be randomized (N = 180 per arm; stratified by weight loss of < or ≥ 5%) to one of two 18-month follow-up conditions conducted between 6-24 months. We will compare the effects of (1) DPP-Sustained (DPP-S) and (2) DPP-Minimal (DPP-M) on measures of weight/adiposity (the primary outcome) at 12, 18, and 24 months. In addition, we will collect cardiometabolic, physical activity, physical function, psychosocial, behavioral and other age-sensitive quality of life measures at 12 and 18 and 24 months. Medicare claims data will also be examined for a proportion of the sample regarding medication use, outpatient, inpatient, and emergency visits and enrollment/participation in elder-focused activity programs. This work, if successful, will have immediate potential for DPP-based lifestyle interventions, which are consistent with a chronic care model, and will benefit vulnerable aging individuals and society.