The National Diabetes Prevention Program in Rural Communities

国家农村社区糖尿病预防计划

• 批准号: 10737009
• 负责人: Anna Michael Gorczyca
• 金额: $ 71.94万
• 依托单位: UNIVERSITY OF KANSAS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-15 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10737009
• 关键词: Address; Adult; Advertising; Age; Agriculture; Body Weight; Body Weight Changes; Body Weight decreased; Centers for Disease Control and Prevention (U.S.); Clinic; Collaborations; Control Groups; County; County Government; Development; Diabetes Mellitus; Distance Learning; Education; Educational Curriculum; Effectiveness; Effectiveness of Interventions; Electronic Health Record; Electronic Mail; Eligibility Determination; Enrollment; Ethnic Origin; Fatty acid glycerol esters; Food; Frequencies; Funding; Glycosylated hemoglobin A; Goals; Grant; Hemoglobin A; Improve Access; Incidence; Income; Individual; Intake; Intervention; Interview; Kansas; Life Style; Maintenance; Mediator; Methods; Minority Groups; Monitor; Non-Insulin-Dependent Diabetes Mellitus; Participant; Patient Recruitments; Physical activity; Population; Practical Robust Implementation and Sustainability Model; Prediabetes syndrome; Prevalence; Prevention; Prevention program; Program Sustainability; Protocols documentation; Race; Randomized; Recommendation; Recruitment Activity; Research; Rural; Rural Community; Schedule; Self Direction; Services; Site; Structure; Techniques; Time; Training; Universities; Weight Gain; arm; compare effectiveness; comparison intervention; cost; cost comparison; cost effective; cost effectiveness; demographics; diabetes prevention program; effectiveness evaluation; effectiveness/implementation trial; evidence base; high risk; improved; information gathering; intervention cost; intervention delivery; intervention participants; lifestyle intervention; male; meetings; prevent; primary outcome; programs; recruit; remote delivery; rural area; rural counties; rural dwellers; rural health clinic; secondary outcome; sex; treatment arm; underserved rural area; urban area; weight loss program

PROJECT SUMMARY Diabetes disproportionately impacts the 60 million individuals living in rural areas where the prevalence of Type 2 diabetes (T2D) is ~17% higher than in urban areas. The Centers for Disease Control and Prevention’s (CDC) National Diabetes Prevention Program (NDPP) which includes a minimum of 16 weekly core sessions over 6 mos. and 6 monthly maintenance sessions provides the framework for the prevention of T2D in the U.S. NDPP recognized programs are available in ~28% of U.S. counties; however, access to at least 1 NDPP recognized program is significantly lower in rural (2.6%) compared with urban areas (11.1%). The Cooperative State Research, Education and Extension Service, a partnership between the U.S Department of Agriculture, land-grant universities and county governments represents a potentially effective but underutilized site for delivery of NDPP to rural residents. However, evidence to support the effectiveness of the NDPP lifestyle intervention in rural adults with prediabetes defined by CDC criteria, with the intervention delivered by Cooperative Extension staff who have completed CDC approved training and using CDC recommendations for both program curriculum and meeting schedule is unavailable. Distance learning, e.g., group video using Zoom®, for delivery of NDPP is currently approved for CDC recognition. Remote delivery platforms provide a potentially cost-effective strategy for improving participation and retention, which are both important predictors of weight loss and reduced diabetes incidence in NDPP. The proposed 12-mo. Type II hybrid effectiveness- implementation trial will compare the effectiveness of the NDPP protocol delivered via distance learning by agents associated with Kansas State Research and Extension (KSRE) serving as a lifestyle coach (GV-NDPP) vs. a self-directed control arm (SD-NDPP) which will receive the NDPP curriculum on the same schedule used for the GV-NDPP arm delivered to individual participants via an iPad® with available lifestyle coach support. Ten KSRE local units/districts serving rural Kansas counties will be allocated to either active (n=5) or passive recruitment (n=5). Active recruitment will form collaborations with rural health clinics to identify potential participants using clinic electronic health records. Passive recruitment will use traditional recruitment techniques, e.g., flyers, email list serves, media advertising etc. Each of the 10 sites will recruit 16 adults with prediabetes defined using current NDPP criteria living in the county served by KSRE (n=160) who will be randomized (1:1) to one of the 2 intervention arms. Aim 1 will compare weight change between the GV-NDPP and SD-NDPP arms across 12 mos. Secondarily, we will compare the proportion of participants meeting CDC weight loss (≥5%) and physical activity goals (≥150 min./wk.), and changes in hemoglobin A1c across 12 mos. between intervention arms. Aim 2 will compare the effectiveness of passive and active recruitment. Aim 3 will compare the cost and cost effectiveness of delivery (GV-NDPP vs. SD-NDPP) and recruitment (passive vs. active) methods.

项目总结