Reducing cardiometabolic risk and promoting functional health in community-based elders with obesity and pre-diabetes: evaluating sustainable DPP follow-up strategies

摘要 老年人肥胖和糖尿病前期的汇合大大增加了糖尿病的风险， 加速功能衰退、多发性硬化、残疾和死亡。需要更多的研究来完善和 扩大预防性干预措施，以减轻老年人和社会的负担。十多年来，有效的6和 12-一个月的糖尿病预防计划（DPP）生活方式干预措施已成功转化， 显示了积极的影响。然而，开发和评估潜在可扩展程序的努力 符合现行的长期DPP干预指南（最长24个月），并帮助更大的 缺乏达到并维持≥ 5%的推荐减肥目标的参与者比例。我们 科学的前提是，翻译DPP干预措施的评价，主要集中在 减肥诱导策略，必须扩展到包括长期干预， 显示出持久的体重、心脏代谢和功能健康益处，特别是对脆弱的老年人， 以社区为基础的设置。我们之前基于DPP的研究已经记录了电话跟踪的效用- 在6个月的DPP减肥诱导后，63%的65-80岁志愿者样本显示， 肥胖和其他风险因素能够在12个月时维持≥ 5%的体重减轻。尽管有充分的证据表明， 较长时间的生活方式干预产生更好的结果（反映在最新的医疗保险裁决）， 对老年人进行为期24个月的DPP干预的转化研究。我们现在建议利用 以社区为基础，研究我们能否维持以长者为中心的保护长者计划的成效 在24个月的时间内使用潜在的可扩展的治疗组件。我们将招募和招收65-80岁 来自老年社区中心网络的肥胖和糖尿病前期老年人（N = 360）， 老龄化服务。干预计划的排序将与当前的医疗保险政策保持一致。首先，从0- 6个月，经验丰富的生活方式教练将管理DPP视频干预，主要由 为所有参与者提供电话辅导，至少25%来自少数民族/种族群体。接下来，与会者将 随机分配（每组N = 180;按体重减轻<或≥ 5%分层）至两个18个月随访之一 在6-24个月之间进行的条件。我们将比较（1）DPP持续（DPP-S）和 (2)在12、18和24个月时，体重/肥胖（主要结局）指标的DPP-极轻微（DPP-M）。在 此外，我们还将收集心脏代谢、身体活动、身体功能、心理社会、行为和其他 在12、18和24个月时测量年龄敏感的生活质量。医疗保险索赔数据也将被检查 关于药物使用、门诊、住院和急诊就诊的样本比例， 参加/参加以老年人为重点的活动方案。这项工作，如果成功，将立即 基于DPP的生活方式干预的潜力，这与慢性护理模式一致， 脆弱的老年人和社会。

ABSTRACT The confluence of obesity and pre-diabetes in older adults substantially increases the risk of diabetes, and accelerates functional decline, multimorbidity, disability, and death. More research is needed to refine and extend preventive interventions to reduce burden for elders and society. For over a decade efficacious 6- and 12-month Diabetes Prevention Program (DPP) lifestyle interventions have been translated successfully and demonstrated positive impact. However, efforts to develop and evaluate potentially scalable programs conforming to current guidelines for longer term DPP interventions (up to 24 months) and help a greater proportion of enrollees achieve and sustain the recommended weight loss target of ≥ 5% are lacking. Our scientific premise is that the evaluation of translational DPP interventions, which has centered largely on strategies for weight loss induction, must be extended to include longer-term interventions that clearly demonstrate durable weight, cardiometabolic and functional health benefits especially for vulnerable elders in community-based settings. Our previous DPP-based research has documented the utility of telephone follow- up after a 6-month DPP weight loss induction and shown that 63% of a 65-80 year old volunteer sample with obesity and other risk factors were able to sustain ≥ 5% weight loss at 12-months. Despite good evidence that longer duration lifestyle interventions yield better outcomes (reflected in the latest Medicare ruling) there are no translational studies of 24-month long DPP interventions with older adults. We now propose to utilize community based settings to examine whether we can sustain the impact of an elder-focused DPP approach using potentially scalable treatment components over a 24-month period. We will recruit and enroll 65-80 year old adults with obesity and pre-diabetes (N = 360) from a network of senior community centers that provide aging services. The intervention program sequencing will be aligned with current Medicare policy. First, from 0- 6 months, experienced lifestyle coaches will administer a DPP-video intervention anchored primarily by telephone coaching for all participants, at least 25% from ethnic/racial minority groups. Next, participants, will be randomized (N = 180 per arm; stratified by weight loss of < or ≥ 5%) to one of two 18-month follow-up conditions conducted between 6-24 months. We will compare the effects of (1) DPP-Sustained (DPP-S) and (2) DPP-Minimal (DPP-M) on measures of weight/adiposity (the primary outcome) at 12, 18, and 24 months. In addition, we will collect cardiometabolic, physical activity, physical function, psychosocial, behavioral and other age-sensitive quality of life measures at 12 and 18 and 24 months. Medicare claims data will also be examined for a proportion of the sample regarding medication use, outpatient, inpatient, and emergency visits and enrollment/participation in elder-focused activity programs. This work, if successful, will have immediate potential for DPP-based lifestyle interventions, which are consistent with a chronic care model, and will benefit vulnerable aging individuals and society.