Diabetes Prevention Culturally Tailored for Mexican Americans

为墨西哥裔美国人量身定制的糖尿病预防文化

• 批准号: 9310918
• 负责人: SHARON A BROWN
• 金额: $ 62.82万
• 依托单位: UNIVERSITY OF TEXAS AT AUSTIN
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-04-15 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9310918
• 关键词: Acculturation; Address; Adherence; Adopted; Adverse effects; Area; Behavior; Behavior Therapy; Behavioral; Blood Pressure; Candidate Disease Gene; Caring; Clinical; Communities; Community Health Aides; Control Groups; County; Death Rate; Diabetes Mellitus; Diabetes prevention; Diagnosis; Dietary intake; Dietitian; Eating; Education; Educational Intervention; Effectiveness; Effectiveness of Interventions; Enrollment; Ethnic group; Family member; Focus Groups; Food; Genetic Variation; Genetic study; Growth; Guidelines; Health; Health Services Accessibility; Health behavior; Healthy Eating; Hispanics; Hour; Hypertension; Impaired fasting glycaemia; Individual; Intervention; Laboratories; Left Ventricular Hypertrophy; Life Style; Lipids; Maintenance; Measures; Medical; Mexican Americans; Mexico; Minority; Modeling; Monitor; Non-Insulin-Dependent Diabetes Mellitus; Not Hispanic or Latino; Nurses; OGTT; Obesity; Outcome; Participant; Pharmaceutical Preparations; Pharmacology; Physical activity; Physicians; Pollution; Population; Population Programs; Poverty; Prediabetes syndrome; Prevalence; Preventive Intervention; Primary Prevention; Problem Solving; Public Health; Randomized; Resources; Rest; Risk; Rural; Self Management; Side; Sleep Apnea Syndromes; Support Groups; Testing; Texas; Time; Translational Research; Unemployment; Ursidae Family; arm; authority; base; bilingualism; blood glucose regulation; cost; demographics; deprivation; design; diabetes management; diabetes prevention program; diabetes risk; diabetic; endothelial dysfunction; exome sequencing; good diet; health belief; healthy lifestyle; high risk; impaired glucose tolerance; improved; improved outcome; innovation; intervention effect; lifestyle intervention; medically underserved; motivational enhancement therapy; multilevel analysis; non-diabetic; prevent; programs; response; success; treatment as usual; urban area; waist circumference; whole genome

ABSTRACT Starr County is a poor Texas-Mexico border community that is 98% Mexican American and has the highest diabetes-related death rate in Texas. In previous Starr County studies, we tested interventions culturally tailored for Spanish-speaking Mexican Americans diagnosed with type 2 diabetes (T2DM). Each study participant was supported by a family member who also received program benefits; 70% of these supporters did not have diabetes. Compared to the control group, fewer non-diabetic supporters in the experimental group converted to diabetes by 12 months post study entry. The primary purpose of the proposed study is to test the effectiveness of our culturally tailored DSME intervention that will be adapted for preventing, or at least delaying, diabetes onset in Mexican Americans with prediabetes. The intervention will involve: 1) 12 2- hour weekly group educational sessions that emphasize eating and preparing healthy Mexican-American foods and increasing physical activity; 2) 15 2-hour bi-weekly/monthly support group sessions on problem solving the barriers to adopting healthier lifestyles; and 3) 3 booster sessions held at 6-month intervals. We will integrate aspects of the Diabetes Prevention Program, as well as motivational interviewing, and prior to intervention testing, we will conduct focus groups with key individuals in Starr County to confirm the strategy and obtain community support. Intervention effectiveness will be examined using a randomized, repeated measures, pretest/posttest control group design, with an “enhanced” usual care control group. We will enroll 300 Mexican Americans with verified prediabetes from rosters of ongoing Starr County genetic studies. Groups of 10 will be constituted according to the area of the county in which people live; each group will be randomly assigned to experimental or control conditions. Growth curve analysis, using multilevel models, will be used to compare intervention effects on health outcomes over time. We hypothesize that participants in the experimental group, compared to the control group, will have better health outcomes (A1C, FBG, lipids, BP, physical activity, dietary intake, and anthropometric variables [BMI, waist circumference]) at 3, 6, 12, 24, and 36 months post baseline, as well as lower rates of converting to T2DM (OGTT) by 36 months. This study is a significant step in our plan to develop effective culturally tailored health programs for populations at high risk for T2DM.

抽象的 斯塔尔县是得克萨斯州和墨西哥边境的一个贫困社区，98% 是墨西哥裔美国人，拥有最高的人口密度。 德克萨斯州与糖尿病相关的死亡率。在之前的斯塔尔县研究中，我们从文化角度测试了干预措施 专为被诊断患有 2 型糖尿病 (T2DM) 的讲西班牙语的墨西哥裔美国人量身定制。每项研究 参与者得到了一名家庭成员的支持，该家庭成员也获得了计划福利；其中70%的支持者 没有糖尿病。与对照组相比，实验组中非糖尿病支持者较少 进入研究后 12 个月，该组转变为糖尿病。拟议研究的主要目的是 测试我们根据文化定制的 DSME 干预措施的有效性，该干预措施将适用于预防或在 患有糖尿病前期的墨西哥裔美国人的糖尿病发病最迟。干预措施将涉及：1) 12 2- 每周一小时的团体教育课程，强调健康的墨西哥裔美国人的饮食和准备 食物和增加体力活动； 2) 15 次每两周/每月一次每次 2 小时的问题支持小组会议 解决采取更健康生活方式的障碍； 3) 每 6 个月举行 3 次加强会议。我们 将整合糖尿病预防计划的各个方面以及动机性访谈，并在 干预测试，我们将与斯塔尔县的关键人物进行焦点小组，以确认该策略 并获得社区支持。将使用随机、重复的方法来检查干预效果 措施，测试前/测试后对照组设计，以及“增强”的常规​​护理对照组。我们将报名 斯塔尔县正在进行的基因研究名单中，有 300 名墨西哥裔美国人被证实患有糖尿病前期。 根据所居住县的面积组成10人一组；每组将 随机分配到实验或控制条件。使用多层次模型的增长曲线分析将 用于比较随着时间的推移干预措施对健康结果的影响。我们假设参与者 与对照组相比，实验组将有更好的健康结果（A1C、FBG、血脂、 3、6、12、24 时的血压、体力活动、饮食摄入量和人体测量变量 [BMI、腰围]） 基线后 36 个月，以及转为 T2DM (OGTT) 的比率降低 36 个月。这项研究 这是我们为高收入人群制定有效的文化定制健康计划的计划中的重要一步 T2DM 的风险。