Physical Activity & Diet to Reduce Diabetes Risk

体力活动

• 批准号: 7031394
• 负责人: Anita L. Stewart
• 金额: $ 43.61万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-09-30 至 2010-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7031394
• 关键词: African American; Hispanic Americans; clinical research; clinical trials; community health services; diabetes education; diabetes risk; diet therapy; disease /disorder prevention /control; exercise; health disparity; health service demonstration project; health services research tag; human middle age (35-64); human subject; human therapy evaluation; longitudinal human study; low socioeconomic status; noninsulin dependent diabetes mellitus; nutrition related tag; outcomes research; prediabetic state; racial /ethnic difference; southeast Asian; weight loss

DESCRIPTION (provided by applicant): Most racial/ethnic minority adults have higher rates of type 2 diabetes (T2DM) and its physiologic and behavioral risk factors than their White counterparts. Lifestyle changes can reduce the risk of T2DM in persons with impaired glucose tolerance. This study will test the effectiveness of a lifestyle program to increase physical activity, reduce weight, and improve diet, offered in community-based settings to primarily lower income, minority (African American, Latino, South Asian) adults aged 40+ with "pre-diabetes" (fasting glucose 100-125 mg/dl). Existing public health department staff and community peer educators will provide outreach and conduct the program. The original program, CHAMPS, increased physical activity and reduced weight in persons aged 65-90 in a randomized trial and was diffused in minority communities. CHAMPS provided education and behavior change support to develop a personalized, choice-based regimen that accounted for participants' health, preferences, and readiness to change. Our aims are to: 1) adapt CHAMPS to: a) augment its dietary component; b) meet the needs of our target population, and c) be integrated into the infrastructure of a city and county public health department; and 2) evaluate the effectiveness of an adapted 6-month program (and 6 month maintenance phase) with a 1-yr randomized controlled trial (n=330), and 3) describe costs to health departments of program start-up and provision. The primary outcome is fasting plasma glucose; secondary outcomes are other diabetes risk factors (body weight, waist circumference, physical activity, insulin resistance, blood pressure, dyslipidemia, and the metabolic syndrome) and health-related quality of life. Steps to identify eligible persons include: educational outreach (n=10,903), diabetes risk appraisal (n=8,177), and pre-diabetes screening (n=785) in neighborhoods with health disparities. Mechanisms by which the program reduces physiological risk at 1 year will be explored, e.g., whether changes in fasting glucose are mediated by weight loss or inflammatory factors. This research combines a practical program conducted in real-world community settings with the scientific strength of a randomized trial design. By augmenting the services that public health departments already offer to help prevent T2DM in some of the nation's most at risk groups, this project could serve as a model to potentially narrow the gap between knowledge and practice for diabetes prevention.

描述（由申请人提供）： 大多数种族/少数族裔成年人的 2 型糖尿病 (T2DM) 及其生理和行为危险因素的发病率高于白人。生活方式的改变可以降低糖耐量受损人群患 T2DM 的风险。本研究将测试在社区环境中为主要针对 40 岁以上患有“糖尿病前期”（空腹血糖 100-125 mg/dl）的低收入少数族裔（非裔美国人、拉丁美洲人、南亚人）成年人提供的增加体力活动、减轻体重和改善饮食的生活方式计划的有效性。现有的公共卫生部门工作人员和社区同伴教育者将提供外展服务并开展该计划。最初的计划 CHAMPS 在一项随机试验中增加了 65-90 岁人群的体力活动并减轻了体重，并在少数族裔社区中推广。 CHAMPS 提供教育和行为改变支持，以制定个性化的、基于选择的治疗方案，该方案考虑了参与者的健康、偏好和改变的准备情况。我们的目标是： 1) 使 CHAMPS 适应： a) 增加其饮食成分； b) 满足目标人群的需求，以及 c) 融入市县公共卫生部门的基础设施； 2) 通过为期 1 年的随机对照试验 (n=330) 评估调整后的 6 个月计划（和 6 个月维持阶段）的有效性，以及 3) 描述卫生部门启动和提供计划的成本。主要结果是空腹血糖；次要结局是其他糖尿病风险因素（体重、腰围、体力活动、胰岛素抵抗、血压、血脂异常和代谢综合征）和与健康相关的生活质量。确定合格人群的步骤包括：教育推广（n=10,903）、糖尿病风险评估（n=8,177）以及在存在健康差异的社区进行糖尿病前期筛查（n=785）。将探讨该计划在一年内降低生理风险的机制，例如空腹血糖的变化是否是由体重减轻或炎症因素介导的。这项研究将在现实社区环境中进行的实用计划与随机试验设计的科学力量相结合。通过加强公共卫生部门已经提供的服务，帮助美国一些高危人群预防 T2DM，该项目可以作为一个模型，有可能缩小糖尿病预防知识与实践之间的差距。