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2型糖尿病（T2 DM）及其生理和行为风险因素的发生率高于白色同龄人。生活方式的改变可以降低糖耐量受损人群中T2 DM的风险。这项研究将测试生活方式计划的有效性，以增加体力活动，减轻体重，改善饮食，在社区为基础的设置，主要是低收入，少数民族（非洲裔美国人，拉丁美洲人，南亚人）40岁以上的成年人与“糖尿病前期”（空腹血糖100-125 mg/dl）。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和开展该计划。最初的项目CHAMPS在一项随机试验中增加了65-90岁人群的身体活动并减轻了体重，并在少数民族社区推广。CHAMPS提供教育和行为改变支持，以制定个性化的，基于选择的方案，考虑到参与者的健康，偏好和改变的准备。我们的目标是：1）调整CHAMPS，以：a）增加其膳食成分; 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年随机对照试验（n=330）评估6个月适应性计划（和6个月维持期）的有效性; 3）描述计划启动和提供给卫生部门的成本。主要结局是空腹血糖;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）和健康相关生活质量。确定合格人员的步骤包括：教育推广（n= 10，903），糖尿病风险评估（n= 8，177）和糖尿病前期筛查（n=785）在健康差距的社区。将探索该计划在1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子介导。这项研究结合了在现实世界社区环境中进行的实际项目和随机试验设计的科学优势。通过加强公共卫生部门已经提供的服务，以帮助预防T2 DM在一些国家的最危险的群体，该项目可以作为一个模式，有可能缩小知识和实践之间的差距差距糖尿病预防。

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.