WEIGHT MANAGEMENT EXPERT SYSTEMS FOR DIABETES

大约90%的NIDDM患者超重。超重可加重病程和合并症，增加卫生保健利用率、发病率和死亡率。以诊所为基础的体重管理计划成本高昂，而且只为一小部分高危人群提供服务。因此，基于人群的行为改变计划可能是必要的，以达到更大比例的风险个人更具有成本效益。初步研究的跨理论模型（TTM）的健康行为参与体重管理的应用表明，该模型有可能指导有效的多行为干预措施的发展。该快速通道建议的第一阶段涉及基于TTM的阶段匹配的、个性化的、交互式干预的定制和可行性测试。可行性包括主动招募50%的合格参与者（n=300）参加一项全面体重管理专家系统干预的随机临床试验，并评估干预材料的可接受性。计算机化的专家系统干预措施和阶段匹配的手册主动提供给整个人群可以对目标健康行为以及体重产生前所未有的影响。使用TTM作为基础将提供理论和个性化的框架，该领域的专家已经指出，这是开发更有效和成本效益更高的干预措施所必需的。拟议的商业应用：超重和肥胖对医疗保健提供系统的所有参与者来说都是昂贵的。超过90%的1500万成年NIDDM患者超重，这增加了医疗保健利用率，发病率和死亡率。有效的基于人群的体重管理干预措施，适合处于各个变化阶段的人们，有可能产生重大的健康和财务影响，以及巨大的商业潜力。

Approximately 90% of individuals with NIDDM are overweight. Overweight can exacerbate the course of the disease and co-morbid conditions, increasing health care utilization, morbidity, and mortality. Clinic-based programs for weight management are costly and serve only a small percentage of at risk individuals. Thus, population-based behavior change programs may be necessary to reach larger percentages of at risk individuals more cost- effectively. Preliminary research on the application of the Transtheoretical Model (TTM) to health behaviors involved in weight management suggests that the model has the potential to guide the development of effective multiple-behavior interventions. Phase I of this Fast-Track proposal involves the customization and feasibility test of a stage-matched, individualized, interactive intervention based on the TTM. Feasibility includes proactively recruiting 50% of eligible participants (n=300) to participate in a randomized clinical trial of a comprehensive weight management expert system intervention and evaluating acceptability of the intervention materials. Computerized expert system interventions and stage-matched manuals delivered proactively to entire populations can have unprecedented impacts on the targeted health behaviors as well as weight. Using the TTM as the basis will provide the theoretical and individualized framework that experts in the area have indicated is necessary to develop more effective and cost- effective interventions. PROPOSED COMMERCIAL APPLICATIONS: Overweight and obesity are costly to all participants in the health care delivery system. Over 90% of the 15 million adults with NIDDM are overweight, which increases healthcare utilization, morbidity, and mortality. Effective population-based weight management interventions that are appropriate for people at all stages of change have the potential to have significant health and financial impacts, as well as tremendous commercial potential.