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状态。工地干预 为向糖尿病前期患者提供公共卫生干预措施提供了一个有希望的框架，因为 在成年后的大部分时间里，工作场所会接触到很大一部分人口。长期发展的机会 通过工作场所的跟踪和支持可能比通过以诊所为基础的计划更大。工作地点 通过改变生活方式促进减肥的干预措施降低了患2型糖尿病的风险 高危人群。然而，在遵循标准生活方式的减肥反应中存在异质性 干预和早期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反应者的额外体重减轻。 此外，有效的减肥维持方法，特别是在工作场所，还不是很广为人知。 持续的联系和支持，经常自我衡量，以及在解决问题和减少障碍方面的技能培养 提供承诺作为减肥维持的干预策略。因此，这项研究的目的是 评估为期16周的基于目标的团体生活方式平衡(GLB)标准干预对 糖尿病预防到干预的替代版本(GLB+)，该版本通过培训进行重组 改变、解决问题和实现目标的认知和情感因素。大学员工 至少21岁的糖尿病前期患者(n=236)将被招募并接受 标准的GLB干预。在干预第5周未能达到2.5%体重减轻的参与者将 在剩下的12周内接受GLB+干预。为期16周的核心干预阶段将是 随后是为期8个月的延长干预阶段，以促进减肥维持。追随核心 干预阶段，将根据性别和体重百分比变化创建匹配的参与者对 从基线开始。两个人中的每个人将被随机分配到延长干预阶段 标准GLB干预或GLB+干预的扩展干预阶段。六个月来没有 接触维护阶段将在延长干预阶段之后进行。干预措施对 体重(主要结果)、空腹血糖、血脂、血压、饮食摄入量、 体力活动、生活质量以及与解决问题和设定目标相关的结构将在 4个月、12个月和18个月。还将进行成本效益分析，以确定收益是否 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。建议数 这项研究将使评估可持续糖尿病预防计划的实际方法成为可能 大学工作场所和强化护理对早期治疗无反应和体重减轻的影响 维修。

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.