Real-world effectiveness of structured lifestyle interventions in preventing type 2 diabetes

摘要 2018年，估计有8800万18岁及以上的美国人，约占成年人的三分之一。 美国人群有前驱糖尿病。2002年，糖尿病预防计划的临床试验表明， 强化生活方式干预，旨在使初始体重降低并维持7%， 增加适度的体力活动到每周150分钟，糖尿病的发病率降低了58%，而不是2.8 年2010年，国会授权疾病控制和预防中心（CDC）建立， 管理和扩大国家糖尿病预防计划（DPP）。入组的资格标准 DPP（空腹血糖100-125 mg/dl或2小时血糖140-199 mg/dl或血红蛋白A1 c 5.7-6.7%或高风险 ADA/CDC糖尿病前期风险筛查评分或妊娠糖尿病个人史）比 在临床试验中使用的那些，干预的形式（组与个人），提供人员 干预（医务人员与受过培训的非专业领导人）、交付模式（面对面与虚拟 （远程医疗）与在线），以及持续时间（3年与1年）都与临床试验不同。虽然 试验表明，干预措施是有效的，具有成本效益，长期有效性， 在现实环境中实施的类似DPP的方案的成本效益尚未确定。的 本建议的目的是评估个人和系统一级参与《公约》的障碍和促进因素， 国家DPP/Medicare DPP，并评估DPP的长期有效性和成本效益， 在现实世界中实现。通过评估个人和系统层面的障碍和促进因素， 参与DPP，并通过评估DPP的长期有效性和成本效益， 在现实世界中实施，这项研究将提供关键信息，以提高吸收和影响 在美国的糖尿病的DPP。

ABSTRACT In 2018, an estimated 88 million Americans 18 years of age and older or approximately one-third of the adult U.S. population had prediabetes. In 2002, the Diabetes Prevention Program clinical trial demonstrated that an intensive lifestyle intervention designed to produce and maintain a 7% reduction in initial body weight and increase moderate physical activity to 150 minutes per week reduced the incidence of diabetes by 58% over 2.8 years. In 2010, Congress authorized the Centers for Disease Control and Prevention (CDC) to establish, manage, and expand the National Diabetes Prevention Program (DPP). Eligibility criteria for enrollment in the DPP (fasting glucose 100-125 mg/dl or 2-hour glucose 140-199 mg/dl or hemoglobin A1c 5.7-6.7% or high risk score on ADA/CDC prediabetes risk screener or personal history of gestational diabetes) were broader than those used in the clinical trial, the format of the intervention (group versus individual), the personnel delivering the intervention (medical personnel versus trained lay leaders), the delivery mode (in-person versus virtual (telehealth) versus online), and the duration (3 years versus 1 year) all differed from the clinical trial. Although the trial demonstrated that the intervention was both effective and cost-effective, the long-term effectiveness and cost-effectiveness of DPP-like programs implemented in real-world settings have not been established. The purpose of this proposal is to assess individual and system-level barriers to and facilitators of participation in the National DPP/Medicare DPP and to evaluate the long-term effectiveness and cost-effectiveness of the DPP as implemented in real-world settings. By assessing individual and system level barriers to and facilitators of participation in the DPP, and by evaluating the long-term effectiveness and cost-effectiveness of the DPP as implemented in real-world settings, this study will provide information critical to improving the uptake and impact of the DPP on diabetes in the United States.