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Improving Weight Loss and Cardiometabolic Risk in Black Primary Care Patients with Obesity and Diabetes

改善患有肥胖和糖尿病的黑人初级保健患者的体重减轻和心脏代谢风险

基本信息

批准号：
10437095
负责人：
Peter Todd Katzmarzyk
金额：
$ 75.56万
依托单位：
UNIVERSITY OF ALABAMA AT BIRMINGHAM
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-24 至 2026-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10437095
关键词：
Address Adult African American Alabama American Behavioral Body Weight Body Weight decreased Body mass index Cardiometabolic Disease Caring Chronic Chronic Disease Clinic Visits Communication Computerized Medical Record Consolidated Framework for Implementation Research Continuity of Patient Care Cost Effectiveness Analysis Deep South Diabetes Mellitus Dietary intake Effectiveness Focus Groups Glycosylated hemoglobin A Goals Graph Health Health Services Accessibility Health Technology Healthcare Systems Improve Access Individual Institutes Integrated Health Care Systems Intervention Interview Level of Evidence Louisiana Low income Medical Minority Groups Mission Mississippi Modeling Non-Insulin-Dependent Diabetes Mellitus Obesity Outcome Patient Care Patient Care Team Patient Outcomes Assessments Patients Personal Communication Pharmaceutical Preparations Physical activity Population Prevention Primary Health Care Public Health Quality of life Randomized Reach, Effectiveness, Adoption, Implementation, and Maintenance Research Risk Factors Science Services Structure Technology Testing Time Translations Transportation Underserved Population United States Urban Health Videoconferencing Weight aged black patient cardiometabolic risk cardiovascular disorder risk caucasian American clinically significant collaborative care contextual factors cost effectiveness diabetes management digital digital medicine disparity reduction effective intervention effectiveness implementation study effectiveness testing evidence base experience fasting plasma glucose glycemic control health care service health disparity health equity health literacy health related quality of life hybrid type 1 study implementation intervention implementation outcomes implementation science improved individual patient innovation lifestyle intervention minority health novel strategies obese patients obesity treatment patient health information patient oriented patient portal primary care setting primary outcome programs remote delivery secondary outcome sleep quality success therapy design treatment as usual weight loss intervention weight loss program

项目摘要

PROJECT SUMMARY/ABSTRACT Type 2 diabetes is a major health concern in the United States, and underserved and minority populations share a disproportionate amount of the burden. Further, the Deep South has higher rates of obesity, diabetes, and other chronic conditions than other regions. Modest weight loss can significantly improve cardiometabolic risk and several health outcomes in patients with diabetes. This study will examine the effectiveness of integrating primary care with a health coach who remotely delivers care, facilitated by the patient portal of an electronic medical record (EMR), in Black patients with obesity and type 2 diabetes. We will also assess the contextual factors of the intervention settings that may influence utilization and dissemination of the weight loss intervention. The study group will include Black primary care patients aged 18-70 years with obesity and type 2 diabetes. We will randomly assign 352 individuals equally to an EMR-facilitated behavioral weight loss intervention and a usual care group for 24 months. Patients in the weight loss group will receive a comprehensive, high-intensity behavioral weight loss program delivered by a health coach using interactive electronic health (eHealth) technology including video conferencing, with a strong emphasis on bi-directional communication. Through an EMR patient portal, patients will have access to program materials and personalized weight loss graphs to track their progress. Patients in the usual care group will continue to receive routine medical care by their primary care practitioner. We hypothesize that patients in the weight loss group will have greater and clinically significant percent reductions in body weight compared to patients in the usual care group. We further hypothesize that patients in the weight loss group will have greater improvements in secondary outcomes, including fasting plasma glucose, hemoglobin A1c, cardiovascular disease risk factors, and patient-reported outcomes such as medication use, sleep quality, mobility, dietary intake, physical activity, and quality of life. Finally, we will study the implementation of the intervention using focus groups, semi- structured interviews, and cost-effectiveness analysis in order to better understand external validity and implementation outcomes. The proposed study will significantly advance the translation of evidence-based weight loss strategies into primary care that are widely applicable to the growing diabetes population in the United States, particularly in the Deep South.

项目概要/摘要 2 型糖尿病是美国以及服务水平低下的少数群体的主要健康问题分担不成比例的负担。此外，南方腹地的肥胖症、糖尿病、和其他慢性病比其他地区。适度减肥可显着改善心脏代谢糖尿病患者的风险和一些健康结果。这项研究将检验以下方法的有效性：将初级保健与远程提供护理的健康教练相结合，由患者门户网站提供便利肥胖和 2 型糖尿病黑人患者的电子病历 (EMR)。我们还将评估可能影响减肥的利用和传播的干预设置的背景因素干涉。该研究小组将包括 18-70 岁患有肥胖和 2 型肥胖的黑人初级保健患者糖尿病。我们将随机分配 352 名个体进行 EMR 促进的行为减肥干预组和常规护理组为期 24 个月。减肥组的患者将接受由健康教练通过互动方式提供的全面、高强度的行为减肥计划电子医疗 (eHealth) 技术，包括视频会议，重点强调双向沟通。通过 EMR 患者门户，患者将可以访问计划材料和个性化的减肥图表来跟踪他们的进展。常规护理组的患者将继续接受初级保健医生的常规医疗护理。我们假设体重减轻的患者与对照组患者相比，该组患者的体重下降幅度更大且具有临床意义。常规护理组。我们进一步假设减肥组的患者会有更大的改善次要结局，包括空腹血糖、糖化血红蛋白、心血管疾病危险因素、以及患者报告的结果，例如药物使用、睡眠质量、活动能力、饮食摄入量、体力活动、和生活质量。最后，我们将通过焦点小组、半访谈等方式研究干预措施的实施情况。结构化访谈和成本效益分析，以便更好地了解外部有效性和实施成果。拟议的研究将显着推进基于证据的翻译将减肥策略纳入初级保健，广泛适用于不断增长的糖尿病人口美国，特别是在南方腹地。