Enhancing the Diabetes Prevention Program to promote weight loss among non-responders in a community based lifestyle intervention
加强糖尿病预防计划,通过基于社区的生活方式干预促进无反应者减肥
基本信息
- 批准号:10654722
- 负责人:
- 金额:$ 54.1万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2020
- 资助国家:美国
- 起止时间:2020-07-15 至 2025-06-30
- 项目状态:未结题
- 来源:
- 关键词:AdherenceAdoptedAdultAfrican American populationAftercareAgeBehaviorBlack PopulationsBlack raceBlood PressureBody Weight decreasedCenters for Disease Control and Prevention (U.S.)ChurchClinicalCommunitiesCommunity Health AidesCost AnalysisDietDisparityDisparity populationEarly InterventionEquilibriumEthnic PopulationExpenditureFutureGenderGoalsIndividualInterventionIntervention StudiesLife StyleMediatingMediationMediatorMissionModelingMorbidity - disease rateMotivationNational Institute of Diabetes and Digestive and Kidney DiseasesNon-Insulin-Dependent Diabetes MellitusNot Hispanic or LatinoObesityOutcomeOutcome MeasureParticipantPatternPersonsPhasePhysical activityPopulationPrevalencePsychosocial FactorPublic HealthRandomized, Controlled TrialsResearchResearch PersonnelRisk FactorsSelf EfficacySiteSocial supportSocioeconomic StatusStandardizationStressStructureTelephoneTimeTrainingTranslationsTreatment outcomeUnited States Centers for Medicare and Medicaid ServicesVariantWeightWorkactive controlactive control grouparmclinically significantcostcost effectivediabetes prevention programdietaryexperiencegroup interventionhuman old age (65+)improvedincremental costintervention effectintervention programlifestyle interventionmalemeetingsmortality riskoverweight adultspaymentpersonalized medicinepersonalized strategiesprimary outcomeprogramsracial populationresponsesecondary outcomesexsociodemographic variablesstandard caresuccesstreatment armtreatment groupweight loss intervention
项目摘要
PROJECT SUMMARY
Obesity is the number one and most preventable Type 2 diabetes (T2D) risk factor yet despite a $20 billion
annual expenditure on diet and weight loss efforts, 87% of US adults are overweight or obese. Disparities also
persist, as Non-Hispanic Black adults have a higher obesity prevalence (46.8%) than non-Hispanic Whites
(37.9%) and suffer higher rates of Type 2 diabetes (T2D). The Diabetes Prevention Program (DPP) lifestyle
intervention (LI) demonstrated the clinical benefits of lifestyle intervention and garnered the Center for Disease
Control (CDC) endorsement as the gold standard LI program for US adults. Reimbursable by the Center for
Medicare and Medicaid Services (CMS), the DPP LI is currently disseminated nationally and the national DPP.
While the DPP LI is effective, critical populations don’t achieve clinically significant weight loss in the current
group-based translation paradigm. This is particularly true for Black DPP participants, who show the lowest
adjusted percent weight loss across (3.2%) among all racial/ethnic groups. A lack of weight loss in the early
weeks of intervention is a known predictor of post-treatment outcomes and continues to be a major barrier to
weight loss for Black participants. Additional research on early intervention, with a focus on populations that
experience disparities, is urgently needed as the new CMS payment structure (based on weight loss metrics)
may further limit access to the DPP for Blacks. This project proposes a cluster randomized control trial with
500 Black participants who are nested in 20 community sites, primarily churches. Trained community health
workers will deliver a group-based, 6-month long DPP Group Lifestyle Balance (DPP-GLB) over 18 sessions
and nonresponders will be identified at four weeks. Nonresponders in the intervention group only will receive
weekly telephone support from the CHWs to provide individual-level enhanced treatment to help them
overcome barriers to adherence to the program goals. These activities will meet the following Specific Aims: 1)
To evaluate differences over time in the primary outcome of weight, and secondary outcomes (i.e., physical
activity level, blood pressure, and dietary behaviors) between nonresponders in the intervention group
compared to nonresponders in the active control group. 2) To examine potential mediators (social support,
self-efficacy, motivation, stress) and moderators (age, sex, socioeconomic status) of the relationship between
treatment group and early weight loss response in the both nonresponders and responders.3) To evaluate the
cost of the intervention arm by comparing the incremental cost and weight loss with the active control arm.
Outcome measures include weight (primary); secondary outcomes include blood pressure, physical activity,
dietary behaviors, mediation and moderator effects and cost. If found to efficacious, the enhanced strategies
for nonresponders could be standardized as a supplement for use with the national DPP and may be
supported by current DPP payers.
项目总结
肥胖是2型糖尿病(T2D)的头号和最可预防的风险因素,尽管有200亿美元
每年在饮食和减肥努力上的支出,87%的美国成年人超重或肥胖。差距也是如此
持续存在,因为非西班牙裔黑人成年人的肥胖率(46.8%)高于非西班牙裔白人
(37.9%),并患有较高的2型糖尿病(T2D)。糖尿病预防计划(DPP)的生活方式
干预(LI)展示了生活方式干预的临床好处,并获得了疾病中心
美国疾病控制与预防中心(CDC)作为美国成年人LI计划的黄金标准。可由中心报销的费用
在医疗保险和医疗补助服务(CMS)中,DPP Li目前在全国范围内传播,并在全国范围内传播。
虽然DPP LI是有效的,但关键人群在目前的临床上并不能实现显著的体重减轻
基于群体的翻译范式。对于黑人民进党参与者来说尤其如此,他们表现出最低的
所有种族/民族的调整后体重减轻百分比(3.2%)。体重在早期没有减轻
几周的干预是已知的治疗后结果的预测指标,并且仍然是
为黑人参与者减肥。关于早期干预的其他研究,重点是以下人群
体验差异,迫切需要新的CMS支付结构(基于减肥指标)
可能会进一步限制黑人进入民进党。该项目提出了一项整群随机对照试验,
500名黑人参与者,他们嵌套在20个社区地点,主要是教堂。训练有素的社区卫生
工作人员将在18个课程中提供为期6个月的基于小组的DPP Group Lifestyle Balance(DPP-GLB)
而无响应者将在四周后确定。只有干预组中的无响应者才会收到
每周由卫生福利院提供电话支援,为他们提供个别层面的强化治疗,帮助他们
克服实现计划目标的障碍。这些活动将达到以下具体目标:1)
评估体重的主要结果和次要结果(即,体格)随时间的差异
活动水平、血压和饮食行为)在干预组中无反应者之间
与主动控制组中的无反应者相比。2)审查潜在的调解人(社会支持、
自我效能感、动机、压力)和调节变量(年龄、性别、社会经济地位)之间的关系
治疗组无反应者和有反应者的早期体重减轻反应。3)评估
通过比较干预臂的增量成本和体重减轻与主动控制臂的成本。
结果测量包括体重(主要);次要结果包括血压、体力活动、
饮食行为、调节和调节作用以及成本。如果被发现是有效的,增强的策略
作为国家民进党使用的补充,可以标准化,并可能是
由目前的民进党支付者支持。
项目成果
期刊论文数量(1)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
Reaching high-risk Black adults for diabetes prevention programming during a pandemic: The design of Fit & Faithful a randomized controlled community trial.
- DOI:10.1016/j.cct.2022.106973
- 发表时间:2022-12
- 期刊:
- 影响因子:2.2
- 作者:Williams LB;Moser DK;Gustafson A;Waters TM;Rayens MK;Karle ER;Kriska AM
- 通讯作者:Kriska AM
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{{ truncateString('Lovoria B Williams', 18)}}的其他基金
Enhancing the Diabetes Prevention Program to promote weight loss among non-responders in a community based lifestyle intervention
加强糖尿病预防计划,通过基于社区的生活方式干预促进无反应者减肥
- 批准号:
10443718 - 财政年份:2020
- 资助金额:
$ 54.1万 - 项目类别:
Enhancing the Diabetes Prevention Program to promote weight loss among non-responders in a community based lifestyle intervention
加强糖尿病预防计划,通过基于社区的生活方式干预促进无反应者减肥
- 批准号:
10031224 - 财政年份:2020
- 资助金额:
$ 54.1万 - 项目类别:
Enhancing the Diabetes Prevention Program to promote weight loss among non-responders in a community based lifestyle intervention
加强糖尿病预防计划,通过基于社区的生活方式干预促进无反应者减肥
- 批准号:
10216253 - 财政年份:2020
- 资助金额:
$ 54.1万 - 项目类别:
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