Diabetes Prevention Translation Project: the Healthy LIFESTYLE Project

描述(由申请人提供)：生活方式干预可以预防或延缓2型糖尿病发展的证据已经在几项临床试验中得到证明，其中包括美国的一项多中心临床试验，即糖尿病预防计划(DPP)。公共卫生面临的挑战是将民进党研究工作中使用的这种有前景的和经过验证的行为干预措施转化为“现实世界”，即如何以更低的成本在各种当地环境中的不同社区发挥作用，以便最大限度地使处于危险中的人受益。本应用程序的目的是测试DPP翻译框架，该框架包括：1)演示社区卫生保健专业人员的培训模式，其中包括在提供糖尿病预防课程和所需的行为生活方式材料方面的初步培训、支持和监督；2)评估针对每个参与者选择的版本(标准面对面小组格式或相同生活方式干预计划内容的DVD版本)实施的更紧凑和灵活的DPP干预计划。这些生活方式干预计划将在三个不同的社区环境中进行；即卫生保健实践、工作场所和当地老年社区中心。最后，对三种社区环境下生活方式干预项目的成本-效果分析进行检验。如果被证明是有效的，这个糖尿病和心血管风险预防转换框架可以在美国和国外推广。 公共卫生相关性：这项建议是从承诺的随机临床试验到社区有效努力的合乎逻辑的下一步，该临床试验利用基于目标的行为生活方式干预来预防2型糖尿病。我们召集了一个调查团队来指导和评估以社区为基础的生活方式干预计划的所有方面，包括培训模式，以扩大标准化有效干预交付的覆盖范围。还将对这些努力进行成本分析。

DESCRIPTION (provided by applicant): Evidence that lifestyle intervention can prevent or delay the development of type 2 diabetes has been demonstrated in several clinical trials including a multi center clinical trial in the US, the Diabetes Prevention Program or DPP. The challenge for public health is to translate this promising and proven behavioral intervention utilized in the DPP research effort to the "real world", i.e., how to make it work in diverse communities in a variety of local settings at a reduced cost so that the maximal number of those at risk can benefit. The purpose of this application is to test a framework for translation of the DPP that includes: 1) demonstration of a training model for community health care professionals that includes initial training, support, and supervision in the delivery of a diabetes prevention curriculum and the needed behavioral lifestyle materials; 2) evaluation of a more compact and flexible DPP intervention program administered to each participant in a version of his or her choice (standard face-to-face group format or a DVD version of the same lifestyle intervention program content). These lifestyle intervention programs will be carried out in three different community settings; i.e. a health care practice, a worksite, and local senior community centers. Lastly, the cost- effectiveness analyses of the LIFESTYLE intervention program in each of the three community settings will be tested. If proven to be effective, this framework for diabetes and cardiovascular risk prevention translation is one that could be adapted throughout the United States and abroad. PUBLIC HEALTH RELEVANCE: This proposal is a logical next step in the progression from promising randomized clinical trials utilizing behavioral, goal-based lifestyle interventions to prevent type 2 diabetes to effectiveness efforts in the community. We have convened a team of investigators to guide and evaluate all aspects of a community- based lifestyle intervention program, including a training model, to expand the reach of standardized effective interventions delivery. A cost-analysis of these efforts will be done as well.