Weight Loss in Primary Care: A Translation of the Diabetes Prevention Program

描述(申请人提供)：肥胖与2型糖尿病发病率的上升有关，需要采取干预措施，导致持续的体重减轻。大多数减肥试验都是在严格控制的条件下在学术中心进行的，后续行动有限。对成功的干预措施进行转化的必要性是显而易见的。由于患者与他们的初级保健医生(PCP)有定期接触，通过初级保健实践提供的干预可能会有更好的长期结果。糖尿病预防计划(DPP)是成功的减肥干预的典范，但到目前为止还没有任何计划成功地使DPP适应基于初级保健的长期干预。这项研究是一项为期5年的随机对照试验，包括两种基于DPP模式的积极治疗干预措施，将在初级保健地点提供。具体目的是评估两种干预措施的效果，这两种干预措施是DPP生活方式平衡计划的翻译，并通过初级保健实践提供，对体重减轻的主要医疗结果、血压、空腹血脂和血糖的次要医疗结果，以及健康行为和健康相关生活质量的心理社会结果的影响。次要目标是确定DPP翻译是否更有效和/或更具成本效益地以组格式交付。受试者将从4个不同的初级保健实践中招募。将有两个积极的治疗小组，都是基于DPP生活方式平衡计划。所有受试者都将与初级保健护士和行为减肥教练保持联系。在第一年，在一个小组中，护士将在电话中陈述12个DPP主题(前5周每周一次，此后每月1次)，教练每月进行3次电话联系，以促进对行为减肥策略的遵守。在第二组中，护士将促成小组电话会议(前5周每周一次，之后每月一次)，以介绍DPP材料并促进同伴支持，教练将每周有3次电话联系，以了解干预的个性化方面。第二年的持续联系也包括在内。这项研究意义重大，因为基于初级保健的电话减肥干预将能够接触到更多的人，可能更有效，而且很容易被初级保健医生采用，帮助他们的患者成功减肥并保持减肥。需要采取能够持续减轻体重的干预措施，以改善公众健康，扭转糖尿病及其心血管并发症和其他肥胖相关疾病令人震惊的上升趋势。 公共卫生相关性：肥胖与2型糖尿病发病率的上升有关，需要采取干预措施，导致持续的体重减轻。这项研究意义重大，因为基于初级保健的电话传递的减肥干预将能够接触到更多的人，可能更有效，而且很容易被初级保健医生采用，帮助他们的患者成功减肥并保持减肥。需要采取能够持续减轻体重的干预措施，以改善公众健康，扭转糖尿病及其心血管并发症和其他肥胖相关疾病令人震惊的上升趋势。

DESCRIPTION (provided by applicant): Obesity is related to the rising incidence of type 2 diabetes and interventions leading to sustained weight loss are needed. Most weight loss trials have been implemented in academic centers under tightly controlled conditions with limited follow-up. The need for translation of successful interventions is clear. Since patients have regular contact with their primary care physicians (PCPs), an intervention that can be delivered through primary care practices could have better long-term outcomes. The Diabetes Prevention Program (DPP) is a model for a successful weight loss intervention, yet no programs to date have successfully adapted the DPP to a long-term primary care-based intervention. The study is a 5 year randomized controlled trial of 2 active treatment interventions based on the DPP model that will be delivered at primary care sites. The specific aims are to evaluate the effects of two interventions that are translations of the DPP Lifestyle Balance program, and are delivered through primary care practices, on the primary medical outcome of weight loss, secondary medical outcomes of blood pressure, fasting lipids and glycemia, and psychosocial outcomes of health behaviors and health-related quality of life. Secondary aims are to determine whether the DPP translation is more effective and/or cost effective delivered in a group format. Subjects will be recruited from 4 diverse primary care practices. There will be 2 active treatment groups, both based on the DPP Lifestyle Balance Program. All subjects will have contact with a primary care nurse and a behavioral weight loss "coach." During the first year, in one group, the nurse will present the 12 DPP topics during phone calls (weekly for first 5 weeks, monthly thereafter) and the coach will make 3 phone contacts per month to promote adherence to behavioral weight loss strategies. In the second group, the nurse will facilitate group conference calls (weekly for first 5 weeks, monthly thereafter) to present the DPP material and foster peer support, and the coach will have 3 weekly phone contacts for the individualized aspects of the intervention. A second year of continued contact is included. The study is significant because a primary care based, telephone weight loss intervention will be able to reach more people, may be more effective, and could be easily adopted by primary care physicians, helping them help their patients lose weight successfully and maintain their weight loss. Interventions leading to sustained weight loss are needed to improve the public health and reverse the alarming rise in diabetes, its cardiovascular complications and other obesity-related illnesses. PUBLIC HEALTH RELEVANCE: Obesity is related to the rising incidence of type 2 diabetes and interventions leading to sustained weight loss are needed. The study is significant because a primary care based, telephone-delivered weight loss intervention will be able to reach more people, may be more effective, and could be easily adopted by primary care physicians, helping them help their patients lose weight successfully and maintain their weight loss. Interventions leading to sustained weight loss are needed to improve the public health and reverse the alarming rise in diabetes, its cardiovascular complications and other obesity-related illnesses.