Telehealth delivery of a weight loss program in diabetes

描述（由申请人提供）：肥胖和2型糖尿病是美国新兴的流行病。减肥可以改善糖尿病的预后，减少对抗糖尿病药物的需求。然而，在初级保健环境中实施行为减肥计划已被证明是一项挑战。基于互联网的减肥计划已被证明是有效的，然而，老年人和低收入人群使用个人电脑的机会有限。此外，计算机需要一定程度的技术复杂性，而互联网的接入对很大一部分糖尿病高危人群构成了障碍。需要一种解决方案，既能提供基于互联网的减肥计划的好处，又不需要技术挑战或成本。本研究的总体目标是探索基于家庭的远程医疗系统Healthium的人体工程学问题，该系统利用宽带连接上的交互式电视系统。待测试的远程保健系统支持音频和视频通信（同步或异步）、医疗提醒、生理监测（如体重）和诊断设备（如血糖仪）、屏幕上的健康状况跟踪、患者教育（音频、文本和多媒体）以及交互式健康调查。该计划将基于先前由研究人员开发的互联网辅助行为减肥计划。拟议的项目将展示如何通过电视机和电视遥控器在患者家中进行饮食和锻炼计划。如果内容能够成功地从PC/互联网环境转移到互动电视平台，我们将能够展示一种方便、直观和廉价的方式来进行与肥胖和营养相关的大规模干预。这可能导致一项可行的公共卫生保健倡议，以预防与肥胖相关的慢性疾病。本提案的具体目标是：1)将一个成功的基于互联网的减肥项目转移到Healthium互动平台上，并进一步开发用于2型糖尿病患者的干预措施。2)进行焦点小组，确定消费者对Healthium界面的便利性和直观性的接受程度。3)在2型糖尿病患者中进行一项试点研究，以确定相对于标准的临床治疗，Healthium界面是否能改善体重减轻和糖尿病预后。

DESCRIPTION (provided by applicant): Obesity and Type 2 diabetes are emerging epidemics in the U.S. Weight loss improves diabetes outcomes and reduces the need for anti-diabetic medication. However, implementation of behavioral weight loss programs in a primary care setting has proven to be a challenge. Internet-based weight loss programs have been shown to be effective, however, access to personal computers is limited among elderly and low-income populations. Additionally, computers require a degree of technical sophistication and access to the Internet poses a barrier for a significant portion of the at-risk diabetes population. A solution is required that offers the benefits of Internet-based weight loss programs without the technical challenges or cost. The overall goal of this study is to explore the human engineering issues of a home-based telehealth system, Healthium, utilizing an interactive television system over a broadband connection. The telehealth system to be tested support audio and video communications (synchronous or asynchronous), medical reminders, physiological monitoring (e.g. body weight) and diagnostic devices (e.g. glucometers), on screen health status tracking, patient education (audio, text and multimedia), and interactive health surveys. The program will be based on Internet-aided behavioral weight loss programs previously developed by the investigators. The proposed project will demonstrate how a diet and exercise program can be conducted with patients in their home via a television set and using the TV remote control. If the content can be successfully transposed from a PC/Internet environment to an interactive television platform, we would be able to demonstrate a convenient, intuitive and inexpensive way to conduct large-scale interventions related to obesity and nutrition. This could lead to a viable public health care initiative for prevention of obesity-associated chronic diseases. The Specific Aims to be addressed in this proposal are: 1) To transfer a successful Internet-based weight loss program onto the Healthium interactive platform and further develop the intervention for use in patients with Type 2 diabetes. 2) To conduct focus groups to determine consumer acceptance of the convenience and intuitiveness of the Healthium interface. 3) To perform a pilot study in patients with Type 2 diabetes to determine whether the Healthium interface improves weight loss and diabetes outcomes relative to standard clinic-based treatment.