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)的超重和肥胖会增加患2型糖尿病和合并症的风险。因此，人们越来越担心美国老龄化人口中2型糖尿病发病率增加对公共健康的影响。对高危样本的研究表明，生活方式干预显著降低了糖尿病风险，老年人的反应尤其敏感，与年轻人相比，他们的体重减轻得更好，糖尿病的发病率更低。然而，尽管已经有关于混合年龄成人队列的方案传播研究，但很少有研究专门侧重于65岁的人，或解决寻找向老年人提供预防方案的可行平台的挑战。这一应用的前提是，在每年的联邦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，以降低患2型糖尿病的风险，这为符合条件的高危成年人提供了一个创新的实际机会。如果被证明是可行和有效的，该计划在公共健康影响和医疗成本控制方面具有很强的潜力。此外，尽管临床研究强调了随着时间的推移持续接触对于帮助个人扩大生活方式干预的益处的重要性，但据我们所知，没有任何传播研究系统地记录了在最初的干预期后持续每月接触的影响。因此，这项申请的总体目标是：1.检查实施团体生活方式平衡12节计划(GLB-12)的可行性和有效性，该计划是一项证据支持的预防计划，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，以及；2.评估持续电话联系在24个月期间改善治疗结果的效用。符合条件的参与者将是320名年龄在65-80岁的非糖尿病成年人，他们的BMI？27和至少一个额外的心脏代谢风险因素。所有参与者都将收到GLB-12，然后将 在剩下的一年干预中，随机接受两种持续联系方案之一，即通过电话(GLB-12+10TC)或时事通讯控制条件(GLB-12+NC)继续小组联系10次。在此交付环境中，将通过报告注册人数、遵守情况、课程完成率以及满意度评级来评估计划的可行性。GLB-12的有效性将通过报告参与者达到5%体重减轻的比例来证明，这是翻译研究中普遍接受的基准，已知在4个月时与良好的心脏代谢结果相关。它还假设，与GLB-12加NC相比，GLB-12加10TC在12个月和24个月时将与更有利的人体测量(体重、腰围)、心脏代谢(葡萄糖、血压、血脂)、身体功能(握力、平衡、步速)以及与健康相关的生活质量结果相关。最后，探索性分析将记录计划成本和计划对医疗利用的影响。 公共卫生相关性：我们建议在符合联邦医疗保险条件的成年人中传播一项新颖而实用的糖尿病预防计划。这项研究将提供4个月、12个月和24个月的数据，以帮助确定持续接触电话干预在提高65-80岁成年人的健康结局和身体功能能力方面是否可行和有效。

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.