Physical Activity and Diet to Reduce Disparities in Diabetes Risk

描述(由申请人提供)： 大多数种族/少数民族成年人的2型糖尿病(T2 DM)及其生理和行为危险因素的发生率高于他们的白人成年人。改变生活方式可以降低糖耐量受损人群患T2 DM的风险。这项研究将测试一项生活方式计划的有效性，该计划旨在增加体力活动、减轻体重和改善饮食，该计划以社区为基础，主要提供给收入较低的、患有糖尿病前期(空腹血糖100-125 mg/dl)的40岁以上的少数民族(非洲裔美国人、拉丁裔、南亚裔)成年人。现有的公共卫生部门工作人员和社区同行教育者将提供外展服务并实施该计划。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，并在少数族裔社区推广。CHAMPS提供教育和行为改变支持，以开发个性化的、基于选择的养生方法，考虑到参与者的健康、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)满足我们目标人群的需求；c)整合到市县公共卫生部门的基础设施中；2)通过1年的随机对照试验(n=330)评估调整后的6个月计划(和6个月维护阶段)的有效性，3)描述计划启动和提供给卫生部门的成本。主要结果是空腹血糖；次要结果是其他糖尿病危险因素(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。确定符合条件的人的步骤包括：教育宣传(n=10,903)，糖尿病风险评估(n=8,177)，以及在健康差距较大的社区进行糖尿病前筛查(n=785)。将探索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由体重减轻或炎症因素介导。这项研究结合了在现实世界社区环境中进行的实际项目与随机试验设计的科学实力。通过加强公共卫生部门已经提供的服务，帮助预防全国一些最危险的人群中的2型糖尿病，该项目可能成为缩小糖尿病预防知识和实践之间差距的典范。

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.