Primary Care-Community Partnerships to Prevent Diabetes

描述(由申请人提供)：糖尿病预防计划(DPP)表明，强化的生活方式干预可以适度减肥和增加体力活动，可以延缓或预防患有糖尿病前期的成年人患2型糖尿病。不幸的是，民进党的生活方式干预并不是为公共卫生规模的实施而设计的。由于糖尿病前期的血糖检测最好在临床环境中进行，基于证据的DPP转换将需要初级保健诊所和社区组织之间的合作伙伴关系，这些组织有能力实施和维持密集的生活方式干预。三年多来，我们一直与初级保健诊所和基督教青年会管理者合作，设计和预先测试一个实用的模式，以识别、咨询和转介高危初级保健患者，以便在青年会设施中获得基于群体的DPP生活方式干预。来自两个R34计划赠款的初步数据提供了强有力的支持，表明糖尿病前筛查和简短咨询在初级保健中是可行的，而且基督教青年会可以实施基于群体的DPP生活方式干预，实现与原始DPP模式相当的减肥效果(-6.0%；95%CI-4.6%至-7.4%)。我们设计了这项拟议的研究，以评估合作方法的成本和有效性，该方法在初级保健环境中识别患有糖尿病前期的成年人，为糖尿病预防提供简短的建议，并在基于社区的基督教青年会分支机构提供对DPP生活方式干预的基于群体的适应。这项研究将涉及8家初级保健诊所、6个基督教青年会地点，为期两年的干预和随访期，并将采用定性和定性相结合的方法来评估初级保健和社区组织中干预活动的覆盖、采用、实施和维持，以及一项实用的随机有效性试验，以评估这种配对干预措施的采用、维持和有效性，以实现和维持患有糖尿病前期的成年初级保健患者的适度体重减轻。如果我们的研究发现这种伙伴干预策略是有效和可持续的，结果将是这种方法作为全国糖尿病预防模式及时和有效传播的关键。

DESCRIPTION (provided by applicant): The Diabetes Prevention Program (DPP) demonstrated that an intensive lifestyle intervention resulting in modest weight loss and increased physical activity can delay or prevent the development of type 2 diabetes in adults with pre-diabetes. Unfortunately, the DPP lifestyle intervention was not designed for delivery on a public health scale. Because glucose tests to identify pre-diabetes are best performed in clinical settings, evidence-based DPP translation will require partnerships between primary care clinics and community organizations that are equipped to implement and sustain an intensive lifestyle intervention. We have been collaborating with primary care clinics and YMCA administrators for over 3 years to design and pre-test a practical model to identify, counsel, and refer high-risk primary care patients for access to a group-based adaptation of the DPP lifestyle intervention in YMCA facilities. Preliminary data from two R34 planning grants provides strong support that pre-diabetes screening and brief counseling is feasible in primary care and that the YMCA can implement a group-based DPP lifestyle intervention and achieve weight loss that is comparable to the original DPP model (-6.0%; 95% CI -4.6 to - 7.4%). We have designed the proposed study to evaluate the costs and effectiveness of a collaborative approach to identify adults with pre-diabetes in primary care settings, deliver brief advice for diabetes prevention, and provide access to a group-based adaptation of the DPP lifestyle intervention at community-based YMCA branch facilities. The study will involve 8 primary care clinics, 6 YMCA sites, and a 2-year intervention and follow-up period and will employ a mix of qualitative and qualitative methods to evaluate the reach, adoption, implementation, and maintenance of intervention activities across primary care and community organizations, as well as a practical randomized effectiveness trial to evaluate the adoption, maintenance, and effectiveness of this partnered intervention to achieve and maintain modest weight loss in adult primary care patients with pre-diabetes. Should our study find this partnered intervention strategy to be effective and sustainable, the results will be pivotal to the timely and efficient dissemination of this approach as a nationwide diabetes prevention model.