Using Peer Support To Aid in PRevention and Treatment in Prediabetes (UPSTART)

项目摘要 据估计，美国有8600万成年人患有前驱糖尿病，低收入的拉丁裔和非洲人 与非西班牙裔成年人相比，美国成年人的发病率高得不成比例。结构化的生活方式 干预措施可以预防或延迟这些高危人群中的2型糖尿病，现在广泛提供的网址是 社区组织和卫生系统。然而，接受和参与现有的正规课程是 非常低。低收入种族和少数民族成年人尤其面临着多重障碍， 参与并持续参与可用的计划和生活方式行为被发现减少 进展为糖尿病。至关重要的是，开发和评估创新方法以增加 吸收、参与和维持糖尿病预防活动中的成果。同行支持一直是 在我们和其他人的有效性试验中显示，这是一种可持续、有效的积极行为方法 改变和改善患有糖尿病和其他慢性病的成年人的结局。我们的试点工作表明 这种方法在低收入的拉丁裔和非裔美国人患者中是可行和可以接受的 糖尿病前期预防慢性病和更好地导航他们的医疗系统以获得健康的生活方式 咨询和支持。然而，这种在拉美裔、非裔美国人和其他低收入群体中的同伴支持模式 患有糖尿病前期的收入成年人还没有得到严格的评估。因此，我们提出了一个平行的， 在两个不同卫生系统的初级保健中心进行的双臂随机对照试验 拉丁裔和非裔美国人高度集中、社会经济多元化的族裔社区 背景。我们将比较加强的日常护理(提供糖尿病预防计划的转介和 资源)和结构化行为改变干预模型，补充了增强的转介 有同伴支持的方案和资源，以帮助将患有糖尿病前期的成年人与现有的卫生系统和 社区糖尿病预防计划，以支持他们参与正式计划，保持已实现的 收获，并支持参与者发起和维持预防糖尿病的健康行为。

Project Abstract An estimated 86 million adults in the United States have prediabetes, and low-income Latino and African American adults have disproportionately high rates compared to non-Hispanic adults. Structured lifestyle interventions can prevent or delay type 2 diabetes in these at-risk populations and now are widely offered at community organizations and health systems. Yet, uptake of and engagement in available formal programs is very low. Low-income racial and ethnic minority adults in particular face multiple barriers to navigating, engaging in, and sustaining involvement in available programs and lifestyle behaviors found to decrease progression to diabetes. It is critically important to develop and evaluate innovative approaches to increase uptake, engagement, and maintenance of gains in diabetes prevention activities. Peer support has been shown in ours and others' effectiveness trials to be a sustainable, effective approach for positive behavior change and improved outcomes in adults with diabetes and other chronic conditions. Our pilot work suggests such approaches are feasible and acceptable among low-income Latino and African American patients with prediabetes to prevent chronic disease and better navigate their health care systems to obtain healthy lifestyle counseling and support. However, such peer support models among Latino, African American, and other low- income adults with prediabetes have not yet been rigorously evaluated. Accordingly, we propose a parallel, two-arm randomized controlled trial in primary care centers in two different health systems that serve multi- ethnic communities with a high concentration of Latinos and African Americans and diverse socio-economic backgrounds. We will compare enhanced usual care (providing referrals to diabetes prevention programs and resources) with a model of a structured behavioral change intervention supplementing enhanced referral to programs and resources with peer support to help link adults with prediabetes to existing health system and community diabetes prevention programs, to support their engagement in formal programs, maintain achieved gains, and support participants to initiate and sustain healthy behaviors to prevent diabetes.