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

描述（由申请人提供）：肥胖与 2 型糖尿病发病率上升有关，需要采取干预措施来实现持续体重减轻。大多数减肥试验都是在学术中心在严格控制的条件下进行的，后续行动有限。成功干预措施的转化的必要性是显而易见的。由于患者定期与初级保健医生 (PCP) 联系，因此通过初级保健实践提供的干预措施可能会产生更好的长期结果。糖尿病预防计划 (DPP) 是成功减肥干预的典范，但迄今为止还没有任何计划成功地将 DPP 改编为基于长期初级保健的干预措施。该研究是一项为期 5 年的随机对照试验，涉及 2 种基于 DPP 模型的积极治疗干预措施，将在初级保健机构实施。具体目标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，对减肥等主要医疗结果、血压、空腹血脂和血糖等次要医疗结果，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 翻译是否以小组形式交付更有效和/或更具成本效益。受试者将从 4 个不同的初级保健实践中招募。将有 2 个积极治疗组，均基于 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”接触。第一年，在一组中，护士将在电话中介绍 12 个 DPP 主题（前 5 周每周一次，此后每月一次），教练每月进行 3 次电话联系，以促进对行为减肥策略的坚持。在第二组中，护士将主持小组电话会议（前 5 周每周一次，此后每月一次），以介绍 DPP 材料并促进同伴支持，教练将每周 3 次电话联系，以了解干预的个性化方面。包括第二年的持续接触。这项研究意义重大，因为基于初级保健的电​​话减肥干预措施将能够惠及更多人，可能更有效，并且可以很容易地被初级保健医生采用，帮助他们帮助患者成功减肥并维持减肥效果。需要采取导致持续减肥的干预措施来改善公众健康并扭转糖尿病、心血管并发症和其他与肥胖相关疾病的惊人上升趋势。 公共卫生相关性：肥胖与 2 型糖尿病发病率上升有关，需要采取干预措施来实现持续体重减轻。这项研究意义重大，因为基于初级保健的电​​话减肥干预措施将能够惠及更多人，可能更有效，并且可以很容易地被初级保健医生采用，帮助他们帮助患者成功减肥并维持减肥效果。需要采取导致持续减肥的干预措施来改善公众健康并扭转糖尿病、心血管并发症和其他与肥胖相关疾病的惊人上升趋势。

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.