Dissemination of a Diabetes Prevention Program among Medicare Eligible Retirees

在符合医疗保险资格的退休人员中传播糖尿病预防计划

• 批准号: 8496775
• 负责人: Elizabeth Mary Venditti
• 金额: $ 50.45万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8496775
• 关键词: Address; Adherence; Adult; Age; Age-Years; Aging; Behavioral; Benchmarking; Blood Pressure; Body Weight; Body Weight decreased; Clinical Research; Cost Control; Data; Development; Diabetes Mellitus; Educational Curriculum; Effectiveness; Elderly; Enrollment; Epidemiology; Equilibrium; Future; Gait; Glucose; Goals; Health; Health Benefit; Healthcare; Incidence; Individual; Insurance Carriers; International; Intervention; Life Style; Lipids; Measures; Medical; Medicare; Metabolic; Monitor; Newsletter; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Outcome; Overweight; Participant; Patient Self-Report; Persons; Pharmaceutical Preparations; Physical Function; Physical activity; Population; Prevention program; Process; Protocols documentation; Public Health; Randomized; Records; Recruitment Activity; Report (document); Reporting; Research; Research Infrastructure; Resources; Risk; Risk Factors; Risk Reduction; Role; Sampling; Speed; Telephone; Time; Translations; Treatment outcome; Universities; Weight; age group; aged; base; blood lipid; cohort; community setting; cost; design; diabetes prevention program; diabetes risk; effective therapy; eligible participant; evidence base; follow-up; grasp; health care service utilization; health related quality of life; high risk; impaired glucose tolerance; improved; innovation; intervention program; lifestyle intervention; meetings; non-diabetic; novel; physical conditioning; physical functional ability; prevent; programs; retiree; satisfaction; screening; treatment duration; young adult

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.

描述（由申请人提供）：有大量证据表明，在晚年（65岁）超重和肥胖会导致2型糖尿病和合并症的重大风险。因此，越来越多的人关注美国老龄化人口中2型糖尿病发病率增加的公共卫生后果。对高风险样本的研究表明，生活方式干预可显着降低糖尿病风险，老年人的反应特别敏感，与年轻人相比，体重减轻更好，糖尿病发病率更低。然而，尽管有混合年龄的成年人队列的方案传播研究，很少有研究专门关注65岁以上的人或解决确定可行的平台，为老年人提供预防方案的挑战。这项申请的前提是，在年度医疗保险登记过程中提供循证生活方式干预，以降低退休人员患2型糖尿病的风险，这为符合条件的高风险成年人提供了一个创新的、实用的机会。如果被证明是可行和有效的，该计划具有强大的潜力，公共卫生的影响和医疗成本控制。此外，尽管临床研究强调了随着时间的推移持续接触在帮助个人延长生活方式干预的益处方面的重要性，但据我们所知，没有任何传播研究系统地记录了初始干预期后每月持续接触的影响。因此，本申请的总体目标是：1.检查实施团体生活方式平衡12节课计划（GLB-12）的可行性和有效性，这是一项证据支持的预防计划，旨在减轻糖尿病风险，作为大型公立大学向高风险退休人员提供的医疗保险福利的一部分; 2。评估24个月内持续电话联系在提高治疗结果方面的效用。符合条件的参与者将是320名年龄在65-80岁之间的非糖尿病成年人，BMI为27并且至少有一个额外的心脏代谢风险因素。所有参与者将收到GLB-12，然后将 在剩余的一年干预中，随机分配至两个持续接触方案之一，通过电话（GLB-12加10 TC）或通讯控制条件（GLB-12加NC）进行10次持续小组接触。计划的可行性将通过报告入学率、坚持率和课程完成率以及在此交付环境中的满意度来评估。GLB-12的有效性将通过报告达到体重减轻<$5%的参与者比例来记录，这是翻译研究中普遍接受的基准，已知与第4个月的有利心脏代谢结局相关。还假设当与GLB-12加NC相比时，GLB-12加10 TC将与12个月和24个月时更有利的人体测量（体重、腰围）、心脏代谢（葡萄糖、血压、脂质）、身体功能（握力、平衡、步态速度）和健康相关的生活质量结果相关。最后，探索性分析将记录项目成本和项目对医疗利用的影响。