Family-Based Prevention of Diabetes & Its Complications

本提案涉及对预防和治疗的临床试验结果进行翻译的需要。 二型糖尿病的发病率上升到社区水平。我们建议与至少包括一个家庭的家庭合作 患有2型糖尿病的成员。这项干预旨在帮助所有家庭成员了解如何收养 已知的健康生活方式可降低糖尿病或其并发症的风险，并更好地利用现有的 社区资源，包括卫生保健系统。一项家庭探访计划之前在 圣路易斯河谷(SLV)的二年级学生将适应于解决预防连续体(初级 在没有糖尿病的家庭成员中预防糖尿病，识别患有糖尿病的家庭成员的二级预防 以前未确诊的糖尿病和糖尿病并发症的三级预防)。这将用两只胳膊来完成 随机设计，250个家庭随机参加家访计划，250个家庭接受常规护理。 探亲计划包括为期6个月的量身定做、亲身实践、以活动为基础的探亲计划，以解决 一级和三级预防(增加体力活动和水果和蔬菜的消费，维持 健康的体重)，并改善支持系统，以便糖尿病家庭成员能够更成功地 听从医生的建议。以活动为基础的小组会议将在#年每月举行一次。 6个月的探亲和完成探亲后的6个月将家庭聚集在一起 强化和推进目标行为。 我们将与医疗保健提供者合作，解决自我管理和社区资源 慢性护理模式的组成部分，以提高医疗质量。这项研究将在旧金山进行。 路易斯谷(SLV)，一个医疗服务不足的地区，48%的人口是西班牙裔；是世界上最低的 科罗拉多州任何地区的人均收入水平；以及过去18年的流行病学调查 记录表明，这是糖尿病、肥胖症、营养不良和缺乏运动的高危人群。 计划的有效性将通过意向治疗比较、中介分析和剂量进行评估 干预组的反应。流程数据将用于描述干预交付以及实施情况 参与者收到的。评估探亲计划所需的费用和其他信息 还将收集和分析有偿治疗和预防服务。

This proposal addresses the need for translation of the results of clinical trials for the prevention and treatment of type 2 diabetes to the community level. We propose to work with families that include at least one family member with type 2 diabetes. The intervention is designed to help all family members learn how they can adopt healthy lifestyles that are known to reduce risk for diabetes or its complications and better utilize existing community resources, including the health care system. A family visit program previously tested in families of second graders in the San Luis Valley (SLV), will be adapted to address the prevention continuum (primary prevention of diabetes in family members without diabetes, secondary prevention identifying family members with previously undiagnosed diabetes, and tertiary prevention of diabetes complications). This will be done in a two-arm randomized design, with 250 families randomized to a family visit program, and 250 families to usual care. The family visit program includes a 6 month tailored, hands-on, activity-based family visit program to address primary and tertiary prevention (increased physical activity and fruit and vegetable consumption, maintenance of healthy body weight) and to improve support systems so that family members with diabetes can more successfully follow their doctors' recommendations. Activity-based group sessions will be conducted on a monthly basis during the 6 months of family visits and for 6 months after family visits are completed bringing families together to reinforce and advance the target behaviors. We will collaborate with health care providers to address the self-management and community resources components of the chronic care model for health care quality improvement. The study will be conducted in the San Luis Valley (SLV), a medically underserved area with 48% of the population being Hispanic; one of the lowest per capita income levels of any region in Colorado; and where epidemiologic investigations over the last 18 years have documented this to be a high risk population for diabetes, obesity, poor nutrition and physical inactivity. Program effectiveness will be evaluated with intent-to-treat comparisons, mediational analysis, and dose response in the intervention group. Process data will be used to describe intervention delivery and how it was received by participants. Costs and other information needed to evaluate the family visit program as a reimbursable treatment and preventive service will also be collected and analyzed.