Dissemination of a Diabetes Prevention Program among Medicare Eligible Retirees

描述（由申请人提供）：有大量证据表明，晚年（65岁）超重和肥胖会增加患2型糖尿病和合并症的风险。因此，人们越来越关注美国老龄化人口中2型糖尿病发病率增加对公共卫生的影响。对高风险样本的研究表明，生活方式干预可以显著降低糖尿病风险，老年人的反应尤其明显，与年轻人相比，他们的体重减轻得更好，患糖尿病的几率也更低。然而，尽管有针对混合年龄成人队列的项目传播研究，但很少有研究专门针对65岁以上的人，或解决确定向老年人提供预防项目的可行平台的挑战。本申请的前提是，在每年的医疗保险登记过程中，为退休人员提供基于证据的生活方式干预，以降低2型糖尿病的风险，这是一个创新的、实用的机会，可以接触到符合条件的、高风险的成年人。如果证明是可行和有效的，该方案将对公共卫生和医疗费用控制产生巨大影响。此外，尽管临床研究强调持续接触对于帮助个人延长生活方式干预的益处的重要性，但据我们所知，还没有传播研究系统地记录了在初始干预期后持续每月接触的影响。因此，这个应用程序的总体目标是：1。检验实施群体生活方式平衡12期项目（GLB-12）的可行性和有效性，这是一个有证据支持的预防项目，旨在降低糖尿病风险，作为向大型公立大学的高风险退休人员提供的医疗保险福利的一部分；2. 评估24个月期间持续电话联系在提高治疗效果方面的效用。符合条件的参与者将是320名非糖尿病成年人，年龄在65-80岁之间，BMI为27，至少有一个额外的心脏代谢危险因素。所有参与者将获得GLB-12，然后将

DESCRIPTION (provided by applicant): There is substantial evidence that overweight and obesity during late life (¿ 65 years of age) confers significant risk for type 2 diabetes and co-morbid conditions. Thus, there is growing concern about the public health consequences of increased incidence of type 2 diabetes in an aging U.S. population. Studies with high risk samples have shown that lifestyle interventions significantly reduce diabetes risk and that elders are particularly responsive, showing better weight loss and lower rates of diabetes development in comparison to younger individuals. However, although there have been program dissemination studies with mixed-age adult cohorts, few studies have focused specifically on persons ¿ 65 years of age or addressed the challenges of identifying workable platforms for delivering prevention programs to older adults. This application is based on the premise that offering an evidence-based lifestyle intervention to reduce risk for type 2 diabetes to retirees during the annual Medicare enrollment process presents an innovative, practical opportunity to reach eligible, high-risk adults. If shown to be feasible and effective, this program has strong potential for public health impact and medical cost-containment. Further, although clinical studies have emphasized the importance of continued contact over time in helping individuals extend the benefits of lifestyle interventions, there are no dissemination studies of which we are aware that have systematically documented the impact of continued monthly contacts after the initial intervention period. Thus, the overall aims of this application are to: 1. examine the feasibility and effectiveness of implementing the Group Lifestyle Balance 12-session program (GLB-12), an evidence- supported prevention program to mitigate diabetes risk, as part of the Medicare benefit offered to high risk retirees at a large public university, and; 2. evaluate the utility of continued telephone contact in enhancing treatment outcome over a 24-month period. Eligible participants will be 320 non-diabetic adults, aged 65-80, with a BMI ¿ 27 and at least one additional cardio-metabolic risk factor. All participants will receive the GLB-12 and then will be randomized to one of two continued-contact protocols for the remaining one year of intervention, 10-sessions of continued small group contact by telephone (GLB-12 plus 10TC) or a newsletter control condition (GLB-12 plus NC). Program feasibility will be assessed by reporting enrollment, adherence and session completion rates, and satisfaction ratings in this delivery context. Effectiveness of the GLB-12 will be documented by reporting the proportion of participants meeting ¿ 5% weight loss, a commonly accepted benchmark in translation studies known to be associated with favorable cardio-metabolic outcomes at month 4. It also is hypothesized that GLB-12 plus 10TC, when compared to GLB-12 plus NC will be associated with more favorable anthropometric (weight, waist), cardio-metabolic (glucose, blood pressure, lipid), physical function (grip strength, balance, gait speed) and health related quality of life outcomes at months 12 and 24. Finally, exploratory analyses will document program costs and program impact on medical utilization. PUBLIC HEALTH RELEVANCE: We propose to disseminate a novel, yet practical, diabetes prevention program among Medicare eligible adults. This study will provide 4, 12, and 24 month data to help determine whether a continued contact telephone intervention is feasible and effective in enhancing health outcomes and physical functional ability in adults aged 65-80.