Impact and sustainability of a digitally-based diabetes prevention program

项目摘要/摘要 糖尿病前期和肥胖症是主要的公共卫生问题，对少数族裔和 美国的低收入个人。大约有8400万美国成年人患有糖尿病前期。 最近糖尿病前期发病率的增加在很大程度上是由全球肥胖症流行造成的。在美国， 最近有报道称，成年人的肥胖率约为40%。随着#年肥胖率的上升 在美国，糖尿病前期预计将成为一个更大的公共卫生挑战。糖尿病的预防 计划试验和其他大型试验表明，通过减少体重可以达到适度的减肥效果 总卡路里摄入量和增加体力活动可以预防或延缓2型糖尿病的发病。 然而，这些涉及面对面咨询的预防计划的实施成本可能会很高 在临床或社区环境中维持较长时间。尖端技术的迅速崛起 数字设备(即移动应用程序、无线活动跟踪器、社交网络)提供了机会 转变医疗团队提供糖尿病预防和减肥计划的方式。这些数字 这些技术价格低廉，可广泛使用，可以接触到大量患有糖尿病前期和 肥胖。然而，尽管它们很受欢迎和可用，但绝大多数人将停止使用它们 在几周内，因为缺乏系统的行为改变方法(即设置个性化的短期和 因此，迫切需要成功地整合这些廉价的数字设备 纳入糖尿病预防和减肥计划，并随着时间的推移保持其效果。这个项目的目标是 评估以英语或西班牙语为基础的数字糖尿病预防计划的效果和可持续性 与患有糖尿病前期和肥胖症的成年人交谈。主要结果是体重百分比和 从基线、5个月和12个月开始计算HbA1c。在这项拟议的为期12个月的随机对照试验中，我们将随机 255名参与者按1：1：1的比例分为3组之一：1)对照组(常规护理)，2)常规干预组， 3)Plus组。而常规组和Plus组都将接受为期5个月的糖尿病预防 以相同的方式进行干预，只有Plus组将接受7个月的维护干预。这个 对照组将收到美国糖尿病协会的生活方式手册，并佩戴活动跟踪器，但 不会提供任何干预。我们的研究团队寻求改变当前的范式，通过使用 用于糖尿病预防和减肥计划的常用数字技术，并测试其可持续性。 我们相信，这项随机对照研究的结果将为如何设计干预措施以及 其他生活方式干预。

Project Summary/Abstract Prediabetes and obesity are major public health issues that disproportionately affect racial/ethnic minorities and low-income individuals in the United States (US). Approximately 84 million American adults have prediabetes. The recent increased prevalence of prediabetes is caused largely by the global epidemic of obesity. In the U.S, the prevalence of obesity was recently reported at about 40% adults. With the growing prevalence of obesity in the U.S., prediabetes is expected to become an even greater public health challenge. The Diabetes Prevention Program trial and other large trials have shown that a moderate amount of weight loss achieved by reducing total caloric intake and increasing physical activity can prevent or delay the onset of type 2 diabetes. However, these prevention programs involving in-person counseling can be expensive to implement and sustain in clinical or community settings over extended periods of time. The rapid rise of sophisticated digital devices (i.e., mobile applications, wireless activity trackers, social network) provides an opportunity to transform the way health care team deliver a diabetes prevention and weight loss program. These digital technologies are inexpensive and widely available and can reach large numbers of adults with prediabetes and obesity. However, despite their popularity and availability, the vast majority of individuals will stop using them within weeks because of lack of systematic behavior change approach (i.e. setting personalized short-term and long-term goals).Therefore, an urgent need exists in successfully incorporating these inexpensive digital devices into a diabetes prevention and weight loss program and sustain its effect over time. The goal of this project is to assess the effect and sustainability of a digitally-based diabetes prevention program in English or Spanish speaking adults with prediabetes and obesity. The primary outcomes are change in percent body weight and HbA1c from baseline, 5, and 12 months. In this proposed 12-month randomized controlled trial, we will randomize 255 participants into one of 3 groups with a 1:1:1 ratio: 1) a Control (usual care), 2) a Regular intervention group, and 3) a Plus group. While both the Regular and Plus group will receive a 5-month diabetes prevention intervention in an identical fashion, only the Plus group will receive a 7-month maintenance intervention. The Control group will receive an American Diabetes Association lifestyle brochure and wear an activity tracker, but no intervention will be provided. Our research team seeks to shift the current paradigm, by moving to the use of commonly used digital technology for diabetes prevention and weight loss programs, and test its sustainability. We believe that the findings from this RCT will provide new insights into how to design interventions as well as other lifestyle interventions.