Impact of Augmented Care at the Worksite for Diabetes Prevention

摘要 在美国，大约40%的人口患有某种高血糖症。工地干预 为向糖尿病前期患者提供公共卫生干预提供了一个有希望的框架，因为 大部分人口在成年后的大部分时间都在工作场所工作。长期的机会 通过工作场所提供的后续行动和支持可能比通过诊所方案提供的更多。工地 通过改变生活方式促进减肥的干预措施可降低2型糖尿病的风险， 高风险的人。然而，在遵循标准生活方式后， 早期对治疗无反应是治疗成功的指标。踏步，或 加强护理可以有效地促进早期无应答者的额外体重减轻。 此外，维持减肥的有效治疗方法，特别是在工作场所，还不为人所知。 持续的联系和支持，经常自我称重，以及解决问题和减少障碍的技能培养 作为维持减肥的干预策略提供承诺。因此，本研究的目的是 评估标准的16周，基于目标的群体生活方式平衡（GLB）干预的影响， 糖尿病预防的替代版本的干预（GLB+），这是重组与培训， 改变、解决问题和实现目标的认知和情感动力。大学员工， 将招募至少21岁的糖尿病前期患者（n=236），并接受前4周的治疗。 标准GLB干预。在干预第5周未能实现2.5%体重减轻的参与者将 在剩余的12周内接受GLB+干预。为期16周的核心干预阶段将是 随后是一个为期8个月的延长干预阶段，以促进减肥的维持。跟随核心 在干预阶段，将根据性别和体重变化百分比创建配对的参与者 从基线。两人中的每个人将被随机分配到延长干预阶段或 标准GLB干预或GLB+干预的扩展干预阶段。6个月不 在延长干预阶段之后将是保持联系阶段。干预措施的影响 体重变化百分比（主要结局）、空腹血糖、血脂、血压、饮食摄入， 身体活动，生活质量，以及与解决问题和目标设定相关的结构将在 4、12和18个月。还将进行成本效益分析，以确定效益是否 与体重变化相关的成本证明了与干预增强相关的成本是合理的。拟议 这项研究将能够评估一个可持续的糖尿病预防计划的实用方法， 大学工作场所和增强护理对早期治疗无反应和体重减轻的影响 上维护

ABSTRACT In the U.S., approximately 40% of the population has some hyperglycemic condition. Worksite interventions offer a promising framework for delivering public health interventions to people with prediabetes, since worksites reach a large segment of the population for most of their adult life. The opportunity for long-term follow-up and support may be greater through worksites than through clinic-based programs. Worksite interventions that promote weight loss through lifestyle modification reduce risk for type 2 diabetes among those at high-risk. However, there is heterogeneity in the weight loss response following a standard lifestyle intervention, and early non-response to treatment is an indicator of treatment success. Stepped, or augmented, care can be effective in promoting additional weight loss among early non-responders. Furthermore, effective treatments for weight loss maintenance, especially at the worksite, are not well known. Ongoing contact and support, frequent self-weighing, and skill building in problem solving and barrier reduction offer promise as intervention strategies for weight loss maintenance. Therefore, the purpose of this study is to evaluate the impact of the standard 16-week, goal-based Group Lifestyle Balance (GLB) intervention for diabetes prevention to an alternate version of the intervention (GLB+) that is restructured with training in cognitive and emotional agency for change, problem solving, and goal attainment. University employees who are at least 21 years old with prediabetes (n=236) will be recruited and receive the first 4 weeks of the standard GLB intervention. Participants who fail to achieve 2.5% weight loss at intervention week 5 will receive the GLB+ intervention for the remaining 12 weeks. The 16-week core intervention phase then will be followed by an 8-month extended intervention phase to promote weight loss maintenance. Following the core intervention phase, matched pairs of participants will be created based on gender and percent weight change from baseline. Each person in the pair will be randomly assigned to either the extended intervention phase of the standard GLB intervention or to the extended intervention phase of the GLB+ intervention. A 6-month no contact maintenance phase will follow the extended intervention phase. The impact of the interventions on percent change in weight (primary outcome), fasting glucose, lipid panel, blood pressure, dietary intake, physical activity, quality of life, and constructs related to problem solving and goal setting will be determined at 4, 12, and 18 months. Cost effectiveness analysis also will be conducted to determine if the benefits associated with weight change justify the costs associated with intervention augmentation. The proposed study will enable evaluation of a practical approach for a sustainable diabetes prevention program at a university worksite and the impact of augmented care on early non-response to treatment and on weight loss maintenance.