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

项目摘要/摘要 在美国，2型糖尿病是一个主要的健康问题，而且没有得到足够的服务和少数民族人口 分担不成比例的负担。此外，南方腹地的肥胖率、糖尿病、 和其他地区不同的慢性病。适度减肥可以显著改善心脏新陈代谢 糖尿病患者的风险和几种健康后果。这项研究将检验以下措施的有效性 在患者门户的帮助下，将初级保健与远程提供护理的健康指导相集成 电子病历(EMR)，在肥胖和2型糖尿病的黑人患者中。我们亦会评估 可能影响减肥的利用和传播的干预环境的背景因素 干预。研究小组将包括18-70岁的肥胖和2型黑人初级保健患者 糖尿病。我们将随机将352人平均分配到EMR促进的行为减肥中 干预组和常规护理组24个月。减肥组的患者将获得 由健康教练提供的全面、高强度行为减肥计划使用交互式 电子健康(EHealth)技术，包括视频会议，重点是双向 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，以跟踪他们的进展。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。我们假设患者在减肥的过程中 与患者相比，该组患者的体重将有更大且临床显著的百分比减少 常规护理组。我们进一步假设，减肥组的患者将有更大的改善 在次要结果中，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，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，我们将研究利用焦点小组、半干预组实施干预的情况 结构化访谈和成本效益分析，以更好地了解外部效度和 实施成果。拟议的研究将极大地推动循证翻译 将减肥战略纳入初级保健，广泛适用于中国日益增长的糖尿病人口 在美国，特别是在南方腹地。

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.