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

项目概要/摘要 2型糖尿病在美国是一个主要的健康问题， 分担不成比例的负担。此外，南方腹地的肥胖、糖尿病、 以及其他慢性病的发病率。适度的减肥可以显着改善心脏代谢 糖尿病患者的风险和几种健康结果。本研究将探讨 将初级保健与远程提供保健的健康教练相结合， 电子病历（EMR），在黑人肥胖和2型糖尿病患者。我们亦会评估 可能影响减肥的利用和传播的干预设置的背景因素 干预研究组将包括18 - 70岁的肥胖和2型糖尿病的黑人初级保健患者。 糖尿病我们将随机分配352个人平等的电子病历促进行为减肥 干预和常规护理组24个月。减肥组的患者将接受 全面的，高强度的行为减肥计划，由健康教练使用互动 电子健康（eHealth）技术，包括视频会议，重点是双向 通信通过EMR患者门户网站，患者将可以访问程序材料， 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 组中的患者相比， 常规护理组我们进一步假设，体重减轻组的患者将有更大的改善 次要结局，包括空腹血糖、血红蛋白A1c、心血管疾病风险因素， 以及患者报告的结果，如药物使用、睡眠质量、活动性、饮食摄入、身体活动， 和生活质量。最后，我们将研究使用焦点小组，半- 结构化访谈和成本效益分析，以便更好地了解外部效度， 执行成果。这项拟议的研究将大大推进翻译的证据为基础的 减肥策略纳入初级保健，广泛适用于不断增长的糖尿病人群， 美国，尤其是南方腹地。

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.