Enhanced enrollment in the National Diabetes Prevention Program for the underserved: a randomized control trial

项目摘要 2型糖尿病影响9.4%的美国成年人，在种族/民族少数族裔和 社会经济地位低。国家糖尿病预防计划(NDPP)是一项基于证据和 广泛传播的行为干预，通过适度减肥来降低糖尿病发病率。 然而，在长达一年的NDPP中保留是有问题的，并导致不理想的体重减轻，特别是在 西班牙裔、非西班牙裔黑人和低收入非西班牙裔白人参与者。提高NDPP的策略 参与和减肥是当务之急，尤其是对这些群体而言。先行先试的结果 NDPP是基于健康信念模型对NDPP的一种新的增强，受到了高度重视 在1140名不同种族、以低收入为主的非随机队列研究中取得成功 参与者。参加NDPP的75名NDPP前参与者的结果与之前的1,065人进行了比较 受试者使用ANCOVA和多变量Logistic回归。会前参与者留在国家发改委 与没有Pre-Pre的人相比，平均多99.8天(p&lt；.001)和多参加14.3%的会议(p&lt；.001) 会议。会前参与者的体重减轻了2.0%(P&lt；.001)，达到 5%的减肥目标(p&lt；.001)。敏感性分析是一致的。研究结果表明，会前治疗可能是一种 承诺和务实的战略，以提高NDPP的有效性和缩小计划之间的差距 结果，但需要随机对照试验(RCT)来确定NDPP前是否可靠 改善NDPP成果。本研究的目的是：1)进行随机对照研究，比较NDPP出席率 以及接受NDPP前与直接参加NDPP的参与者之间的减肥结果 (通常护理)，2)检查潜在的影响中介因素(患糖尿病的感知风险和自我效能以及 体重控制准备情况)和主持人(种族/族裔和收入水平)，以及3)评估实施情况 因素，包括成本和预计投资回报。长期目标是传播一种可扩展的、 以证据为基础的战略，以提高国家发展方案的成功，减少国家发展方案有效性方面的差距。如果 经证实是有效的，NDPP前可以向所有NDPP提供者传播，包括1700多个NDPP 网站，并可能得到当前NDPP付款人的支持，如联邦医疗保险、商业保险公司和雇主 组。因此，这种方法很有可能影响2型糖尿病和相关健康的负担。 全国各地的差异。

Project Summary Type 2 diabetes affects 9.4% of US adults with higher rates among racial/ethnic minorities and individuals of low socioeconomic status. The National Diabetes Prevention Program (NDPP) is an evidence-based and widely disseminated behavioral intervention to reduce diabetes incidence through modest weight loss. However, retention in the yearlong NDPP is problematic and leads to suboptimal weight loss, especially among Hispanic, non-Hispanic black, and low-income non-Hispanic white participants. Strategies to improve NDPP engagement and weight loss are needed urgently, especially for these subgroups. Pilot results of the Pre- NDPP, a novel enhancement to enrollment in the NDPP based on the Health Belief Model, were highly successful in a non-randomized cohort study among 1,140 racially diverse, predominately low-income participants. Outcomes of 75 Pre-NDPP participants who enrolled in the NDPP were compared to 1,065 prior participants using ANCOVA and multivariable logistic regression. Pre-session participants stayed in the NDPP 99.8 days longer (p<.001) and attended 14.3% more sessions (p<.001) on average than those without a pre- session. Pre-session participants lost 2.0% more weight (p<.001) and were 3.5 times more likely to achieve the 5% weight loss target (p<.001). Sensitivity analyses were consistent. Findings suggest pre-sessions may be a promising and pragmatic strategy to improve NDPP effectiveness and mitigate disparities in program outcomes, but a randomized controlled trial (RCT) is needed to determine whether Pre-NDPP reliably improves NDPP outcomes. The purpose of this study is to 1) conduct an RCT comparing NDPP attendance and weight loss outcomes between participants who receive Pre-NDPP vs. direct enrollment into the NDPP (usual care), 2) examine potential effect mediators (perceived risk for developing diabetes and self-efficacy and readiness for weight control) and moderators (race/ethnicity and income level), and 3) evaluate implementation factors, including cost and projected return on investment. The long-term goal is to disseminate a scalable, evidence-based strategy to improve success of the NDPP and reduce disparities in NDPP effectiveness. If found to be effective, Pre-NDPP can be disseminated to all NDPP providers, including more than 1,700 NDPP sites, and may be supported by current NDPP payers such as Medicare, commercial insurers, and employer groups. Thus, this approach has a high potential to impact the burden of type 2 diabetes and related health disparities across the country.