Family-Based Prevention of Diabetes & Its Complications

描述（由申请人提供）： 该提案解决了将预防和治疗2型糖尿病的临床试验结果转化为社区一级的需要。我们建议与至少有一名家庭成员患有2型糖尿病的家庭合作。该干预措施旨在帮助所有家庭成员了解如何采取健康的生活方式，以降低糖尿病及其并发症的风险，并更好地利用现有的社区资源，包括医疗保健系统。以前在圣路易斯山谷（SLV）的二年级学生家庭中测试的家庭访问计划，将适应于解决预防连续性（在没有糖尿病的家庭成员中进行糖尿病的初级预防，识别以前未诊断糖尿病的家庭成员的二级预防，以及糖尿病并发症的三级预防）。这将在两组随机设计中完成，250个家庭随机分配到家庭访视计划，250个家庭接受常规护理。 家庭探访方案包括一个为期6个月的量身定制、亲身实践、以活动为基础的家庭探访方案，以解决初级和三级预防问题（增加体育活动、水果和蔬菜消费、保持健康体重），并改善支持系统，使糖尿病家庭成员能够更成功地遵循医生的建议。在为期6个月的家庭访问期间，将每月举行一次以活动为基础的小组会议，并在家庭访问结束后的6个月内将家庭聚集在一起，以加强和促进目标行为。 我们将与医疗服务提供者合作，解决长期护理模式中的自我管理和社区资源部分，以提高医疗服务质量。本研究将在圣路易斯山谷（SLV）进行，这是一个医疗服务不足的地区，48%的人口为西班牙裔;是科罗拉多任何地区人均收入水平最低的地区之一;过去18年的流行病学调查证明，这是糖尿病、肥胖、营养不良和缺乏身体活动的高风险人群。 计划的有效性将通过意向治疗比较、中介分析和干预组的剂量反应进行评估。过程数据将用于描述干预措施的实施以及参与者如何接受干预措施。还将收集和分析评估家庭访问计划作为可报销治疗和预防服务所需的费用和其他信息。

DESCRIPTION (provided by applicant): This proposal addresses the need for translation of the results of clinical trials for the prevention and treatment of type 2 diabetes to the community level. We propose to work with families that include at least one family member with type 2 diabetes. The intervention is designed to help all family members learn how they can adopt healthy lifestyles that are known to reduce risk for diabetes or its complications and better utilize existing community resources, including the health care system. A family visit program previously tested in families of second graders in the San Luis Valley (SLV), will be adapted to address the prevention continuum (primary prevention of diabetes in family members without diabetes, secondary prevention identifying family members with previously undiagnosed diabetes, and tertiary prevention of diabetes complications). This will be done in a two-arm randomized design, with 250 families randomized to a family visit program, and 250 families to usual care. The family visit program includes a 6 month tailored, hands-on, activity-based family visit program to address primary and tertiary prevention (increased physical activity and fruit and vegetable consumption, maintenance of healthy body weight) and to improve support systems so that family members with diabetes can more successfully follow their doctors' recommendations. Activity-based group sessions will be conducted on a monthly basis during the 6 months of family visits and for 6 months after family visits are completed bringing families together to reinforce and advance the target behaviors. We will collaborate with health care providers to address the self-management and community resources components of the chronic care model for health care quality improvement. The study will be conducted in the San Luis Valley (SLV), a medically underserved area with 48% of the population being Hispanic; one of the lowest per capita income levels of any region in Colorado; and where epidemiologic investigations over the last 18 years have documented this to be a high risk population for diabetes, obesity, poor nutrition and physical inactivity. Program effectiveness will be evaluated with intent-to-treat comparisons, mediational analysis, and dose response in the intervention group. Process data will be used to describe intervention delivery and how it was received by participants. Costs and other information needed to evaluate the family visit program as a reimbursable treatment and preventive service will also be collected and analyzed.