Intervention based in primary care to increase physical activity among inactive adults with prediabetes and diabetes

基于初级保健的干预措施，以增加患有前驱糖尿病和糖尿病的不活跃成年人的体力活动

• 批准号: 10669156
• 负责人: Deborah R. Young
• 金额: $ 62.54万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-15 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10669156
• 关键词: Accelerometer; Address; Adult; African American population; American; Behavioral; Blindness; Blood Pressure; Body Weight decreased; Body mass index; California; Cardiovascular Diseases; Clinical Preventive Practices; Computerized Medical Record; Counseling; Data; Diabetes Mellitus; Disease; Effectiveness; Effectiveness of Interventions; Eligibility Determination; Evidence based intervention; Exercise; Glycosylated hemoglobin A; Goals; Guidelines; Health; Health Care Sector; Health Personnel; Healthcare Systems; Heart Diseases; Hispanic; Individual; Insulin; Intervention; Intervention Studies; Kidney Failure; Knowledge; Latino; Lipids; Lower Extremity; Malignant Neoplasms; Measures; Mediating; Mexican Americans; National Health and Nutrition Examination Survey; Non-Insulin-Dependent Diabetes Mellitus; Not Hispanic or Latino; Outcome; Outpatients; Participant; Patients; Persons; Physical activity; Physical assessment; Population; Prediabetes syndrome; Prevalence; Primary Care; Quality of life; Race; Randomized; Remission Induction; Risk; Risk Reduction; Strenuous Exercise; Stroke; System; Telephone; Testing; United States Preventative Services Task Force; Visit; aged; blood glucose regulation; brief advice; cardiometabolic risk; comparison intervention; cost; cost effectiveness; diabetes risk; ethnic diversity; exercise intervention; health care delivery; health plan; high risk; human old age (65+); improved; innovation; intervention effect; lifestyle intervention; limb amputation; member; moderate-to-vigorous physical activity; mortality risk; motivational enhancement therapy; neglect; obesity risk; peer; primary care practice; primary care provider; primary care services; primary care setting; primary outcome; progression risk; recruit; secondary outcome; sedentary; social; social cognitive theory; theories; treatment arm; treatment as usual

PROJECT SUMMARY Diabetes is a devastating disease that is increasing in prevalence. Regular physical activity (PA) markedly improves health for all individuals, including those with diabetes and prediabetes. However, only 5% of American adults are sufficiently active to meet U.S. national guidelines. The health sector is an important setting to promote PA because of its ability to reach and influence large numbers of people. Brief health care provider PA assessment and counseling can successfully increase PA in the short-term (< 6 months), but advice during an outpatient visit is insufficient for lasting PA improvements. We propose a trial including members of Kaiser Permanente Southern California (KPSC), an integrated health plan with high racial/ethnic diversity and whose majority membership is Latino. We will build on an existing KP innovation of assessing PA at every outpatient visit by proposing a trial in which the primary care provider determines the suitability of a patient to increase PA, provides brief advice, and refers patients for PA counseling. Eligible patients are then recruited to a 2-year, medium-intensity telephone behavioral counseling intervention or usual care. We focus the trial on adults who have prediabetes or diabetes who are not prescribed insulin because of their high risk for cardiometabolic complications and the great benefit they can obtain from regular PA. The intervention, individualized by the motivational interviewing approach, is generalizable to other health care delivery systems. Electronic medical records will provide data for secondary outcomes. Our long-term goal is to determine if such a PA intervention can be successfully integrated into primary care services. If so, the intervention can be scaled so millions of sedentary patients with diabetes or prediabetes can receive personal advice and PA counseling. To this end, our primary aim is to determine if the study intervention, compared with usual care, increases moderate-to-vigorous PA (assessed by accelerometry) between baseline and 24 months in patients with type 2 diabetes or prediabetes. Our secondary aims are to 1) determine if the intervention improves body mass index (BMI), hemoglobin A1C, blood pressure, lipids, and quality of life, and 2) determine the cost- effectiveness of the intervention. This study has the potential for a very high impact on clinical preventive practices. PA improves numerous diseases and conditions and is seriously neglected in primary care. By documenting the costs and effects of a practical intervention based in primary care on an objective measure of PA, this study will promote a highly significant shift in primary care practice.

项目摘要 糖尿病是一种毁灭性疾病，患病率正在增加。定期体育锻炼（PA）明显 改善所有人的健康，包括患有糖尿病和糖尿病前期的人。但是，只有5％ 美国成年人足够活跃，可以符合美国国家准则。卫生部门是重要的 促进PA的设置是因为它能够触及和影响大量人。简短的医疗保健 提供者PA评估和咨询可以在短期（<6个月）中成功增加PA，但 门诊期间的建议不足以改善PA。我们提出了一个审判，包括 Kaiser Permanente南加州（KPSC）的成员，这是一项综合健康计划，具有高种族/族裔 多样性和多数成员是拉丁裔。我们将以评估PA的现有KP创新为基础 在每一次门诊就诊时，都提出一项试验，其中初级保健提供者决定了 患者增加PA，提供简短的建议，并转介患者进行PA咨询。当时有资格的患者 招募2年中强度的电话行为咨询干预或通常的护理。我们集中精力 对患有糖尿病前期或糖尿病的成年人的试验，因为他们的高风险很高 对于心脏代谢并发症以及它们可以从常规PA获得的巨大好处。干预， 通过动机访谈方法个性化，可以推广到其他医疗保健提供系统。 电子病历将为次要结果提供数据。我们的长期目标是确定是否这样 PA干预可以成功整合到初级保健服务中。如果是这样，干预可以是 缩放量表，因此数百万久坐的糖尿病或糖尿病患者可以接受个人建议和PA 咨询。为此，我们的主要目的是确定研究干预是否与通常的护理相比， 在患者中增加基线至24个月之间中度到剧烈的PA（通过加速度计评估） 2型糖尿病或糖尿病前期。我们的次要目标是1）确定干预是否改善身体 质量指数（BMI），血红蛋白A1C，血压，脂质和生活质量，2）确定成本 - 干预的有效性。这项研究有可能对临床预防产生很大的影响 实践。 PA改善了许多疾病和疾病，在初级保健中被严重忽视。经过 记录基于初级保健的实际干预措施的成本和影响，以客观的衡量 PA，这项研究将促进初级保健实践的高度重大转变。