A Sentinel Network for Evaluation of the Reach, Implementation, Effectiveness, and Costs of Evidence-Based Lifestyle Interventions to Prevent Type 2 Diabetes in U.S. Adults

项目摘要 尽管在糖尿病方面取得了巨大进展，但2型糖尿病（T2 D）是可预防死亡的主要原因， 在美国的残疾人，每年有超过150万的美国人患有T2 D。一半以上 如果向高危成年人提供资源密集型生活方式， 干预计划，而他们有糖尿病前期-一个容易识别的阶段，血糖异常 2型糖尿病的早期症状有哪些？目前，8800万美国人 糖尿病前期，但其中约5/6的人不知道，只有不到1%的人参与了强化生活方式 干预 CDC创建了国家糖尿病预防计划（NDPP），以解决2型糖尿病日益增加的负担。 糖尿病在美国NDPP生活方式改变计划是通过CDC认可的 组织，包括社区组织、医院、提供者团体、药房和卫生 通过各种交付方式（亲自、在线、远程课堂或远程保健）制定计划。2018年以来 医疗保险糖尿病预防计划（MDPP）还提供了一个结构化的生活方式干预计划 旨在预防65岁及以上糖尿病前期患者的2型糖尿病。 我们建议制定和实施一项合作研究数据收集和评估计划， 强调了几个组织的独特的、互补的优势， 提供国家DPP和/或Medicare DPP干预措施，以在多种情况下覆盖不同人群 和多种格式。我们的建议将整合成功评估所需的几个数据来源 参与的障碍和促进因素、执行工作的有效性、成本和成本效益 糖尿病循证预防服务作为NDPP和MDPP的一部分。与大型 卫生系统和DPP供应商在全国几个代表性的“哨兵”位置，我们将收集， 管理、协调和分析多个数据源，包括：（1）卫生系统合作伙伴的数据， 参与者资格特征、参与障碍和促进因素，以及生物识别结果的变化 （2）NDPP供应商关于出勤率、体重变化、参与者体验的数据，以及 实施方面的挑战;以及（3）全国范围内传统医疗保险受益人的大型医疗支付者数据， UnitedHealthCare（UHC）商业保险健康计划在全国范围内注册，UHC Medicare Advantage 在全国范围内注册，在参与NDPP的选定州注册UHC Medicaid Managed Care。

Project Summary Despite tremendous advances in diabetes, Type 2 diabetes (T2D) is a leading cause of preventable death and disability in the U.S., and more than 1.5 million more Americans develop T2D every year. More than half of those new cases could be prevented or delayed if high risk adults were offered resource-intensive lifestyle intervention programs while they have prediabetes – a readily identifiable stage of abnormal glucose metabolism that precedes the development of type 2 diabetes. Currently, 88 million Americans have prediabetes, but about 5 in 6 of them is unaware, and fewer than 1% have participated in an intensive lifestyle intervention. CDC created the National Diabetes Prevention Program (NDPP) to address the increasing burden of type 2 diabetes in the United States. The NDPP lifestyle change program is offered through CDC recognized organizations, including community-based organizations, hospitals, provider groups, pharmacies, and health plans in a variety of delivery approaches (in person, online, remote classroom or telehealth). Since 2018, the Medicare Diabetes Prevention Program (MDPP) has also offered a structured lifestyle intervention program designed to prevent type 2 diabetes in individuals 65 years and older with prediabetes. We propose to develop and implement a collaborative research data collection and evaluation plan that emphasizes the unique, complementary strengths of several organizations with experience supporting the delivery of National DPP and/or Medicare DPP interventions to reach diverse populations in multiple contexts and in multiple formats. Our proposal will integrate several sources of data needed to successfully evaluate participation barriers and facilitators, effectiveness, costs, and cost-effectiveness of efforts to implement evidence-based diabetes prevention services as part of the NDPP and MDPP. In collaboration with large health systems and DPP suppliers in several representative “sentinel” locations nationally, we will collect, manage, harmonize, and analyze multiple data sources, including: (1) health system partner data regarding participant eligibility characteristics, participation barriers and facilitators, and change in biometric outcomes over time; (2) NDPP supplier data regarding attendance levels, weight changes, participant experience, and implementation challenges; and (3) large health payer data for traditional Medicare beneficiaries nationally, UnitedHealthCare (UHC) commercially ensured health plan enrollees nationally, UHC Medicare Advantage enrollees nationally, and UHC Medicaid Managed Care enrollees in select states that participate in NDPP.