A Sentinel Network for Evaluation of the Reach, Implementation, Effectiveness, and Costs of Evidence-Based Lifestyle Interventions to Prevent Type 2 Diabetes in U.S. Adults

项目摘要 尽管在糖尿病方面取得了巨大的进步，但2型糖尿病(T2D)仍然是可预防的死亡和 在美国，每年有超过150万的美国人患上T2D。超过一半的 如果向高危成年人提供资源密集型生活方式，这些新病例可能会被预防或推迟 糖尿病前期的干预计划--血糖异常的一个容易识别的阶段 在2型糖尿病发展之前的代谢。目前，8800万美国人 糖尿病前期，但其中约五分之一的人没有意识到，只有不到1%的人参与了密集的生活方式 干预。 美国疾病控制与预防中心创建了国家糖尿病预防计划(NDPP)，以应对日益加重的2型糖尿病负担 美国的糖尿病患者。NDPP生活方式改变计划是通过CDC认可的 组织，包括基于社区的组织、医院、提供者团体、药房和卫生 计划采用多种交付方式(面对面、在线、远程课堂或远程医疗)。自2018年以来， 医疗保险糖尿病预防计划(MDPP)也提供了一项结构化的生活方式干预计划 旨在预防65岁及以上糖尿病前期患者的2型糖尿病。 我们建议制定和实施一个协作研究数据收集和评估计划， 强调几个组织独特、互补的优势，这些组织具有支持 提供国家DPP和/或医疗保险DPP干预措施，以覆盖多个背景下的不同人群 并且有多种格式。我们的提案将整合成功评估所需的多个数据来源 参与障碍和促进者、执行工作的效力、成本和成本效益 作为NDPP和MDPP一部分的循证糖尿病预防服务。与大型企业合作 卫生系统和民进党供应商在全国几个具有代表性的哨点地点，我们将收集， 管理、协调和分析多个数据源，包括：(1)卫生系统合作伙伴数据，涉及 参与者资格特征、参与障碍和促进者，以及生物测定结果的变化 随时间推移；(2)NDPP供应商关于出席率、权重变化、参与者体验以及 实施挑战；以及(3)全国传统医疗保险受益人的大量医疗支付者数据， UnitedHealthcare(UHC)在商业上确保了全国的医疗计划参与者，UHC Medicare Advantage 全国范围内的参保人，以及参与NDPP的选定州的UHC医疗补助管理保健参保人。

Project Summary Despite tremendous advances in diabetes, Type 2 diabetes (T2D) is a leading cause of preventable death and disability in the U.S., and more than 1.5 million more Americans develop T2D every year. More than half of those new cases could be prevented or delayed if high risk adults were offered resource-intensive lifestyle intervention programs while they have prediabetes – a readily identifiable stage of abnormal glucose metabolism that precedes the development of type 2 diabetes. Currently, 88 million Americans have prediabetes, but about 5 in 6 of them is unaware, and fewer than 1% have participated in an intensive lifestyle intervention. CDC created the National Diabetes Prevention Program (NDPP) to address the increasing burden of type 2 diabetes in the United States. The NDPP lifestyle change program is offered through CDC recognized organizations, including community-based organizations, hospitals, provider groups, pharmacies, and health plans in a variety of delivery approaches (in person, online, remote classroom or telehealth). Since 2018, the Medicare Diabetes Prevention Program (MDPP) has also offered a structured lifestyle intervention program designed to prevent type 2 diabetes in individuals 65 years and older with prediabetes. We propose to develop and implement a collaborative research data collection and evaluation plan that emphasizes the unique, complementary strengths of several organizations with experience supporting the delivery of National DPP and/or Medicare DPP interventions to reach diverse populations in multiple contexts and in multiple formats. Our proposal will integrate several sources of data needed to successfully evaluate participation barriers and facilitators, effectiveness, costs, and cost-effectiveness of efforts to implement evidence-based diabetes prevention services as part of the NDPP and MDPP. In collaboration with large health systems and DPP suppliers in several representative “sentinel” locations nationally, we will collect, manage, harmonize, and analyze multiple data sources, including: (1) health system partner data regarding participant eligibility characteristics, participation barriers and facilitators, and change in biometric outcomes over time; (2) NDPP supplier data regarding attendance levels, weight changes, participant experience, and implementation challenges; and (3) large health payer data for traditional Medicare beneficiaries nationally, UnitedHealthCare (UHC) commercially ensured health plan enrollees nationally, UHC Medicare Advantage enrollees nationally, and UHC Medicaid Managed Care enrollees in select states that participate in NDPP.