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 美国人患有糖尿病前期。2002年，糖尿病预防计划的临床试验表明， 密集的生活方式干预，旨在使初始体重减少7%并保持 将适度体力活动增加到每周150分钟，糖尿病的发病率比2.8%降低了58% 好几年了。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)。参加的资格标准 DPP(空腹血糖100-125 mg/dl或2小时血糖140-199 mg/dl或血红蛋白A1c 5.7-6.7%或高危人群 在ADA/CDC糖尿病前期风险筛查或个人妊娠期糖尿病病史上的得分)比 在临床试验中使用的，干预的形式(团体和个人)，人员提供 干预(医务人员与训练有素的非专业领导者)、交付模式(面对面与虚拟 (远程医疗与在线)，持续时间(3年与1年)都与临床试验不同。虽然 试验证明，该干预措施既有效又经济，长期效果和 在现实世界中实施的类似民进党的计划的成本效益尚未确定。这个 本提案的目的是评估个人和系统层面的障碍和参与的促进者 国家DPP/医疗保险DPP，并评估DPP的长期效果和成本效益 在真实环境中实施。通过评估个人和系统层面的障碍和促进者 参与民进党，并通过评估民进党的长期效果和成本效益为 这项研究将在现实世界环境中实施，将提供对提高理解和影响至关重要的信息 在美国糖尿病问题上的民进党。

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.