Translating the Diabetes Prevention Program to Engage Men in Disadvantaged Areas

描述（由申请人提供）：2型糖尿病的流行率上升是残疾和死亡的主要原因。据估计，2012年糖尿病的成本为2450亿美元，也是美国医疗保健系统的重大负担。继2002年糖尿病预防计划（DPP）的成功试验之后，将这种生活方式干预转化为社区环境一直是一个主要的公共卫生重点，并得到了CDC通过国家糖尿病预防计划（NDPP）的大力支持。尽管NDPP已被证明对登记的参与者有效，导致体重减轻5- 7%，与环境和人口群体无关，但参与程度存在显着差异。参与率 男性的参与率特别低（通常低于30%）;黑人和拉丁美洲男性的参与率甚至更低（低于20%）。男子的健康状况一般比妇女差，预期寿命也比妇女短。与白色男性相比，有色人种男性更容易面临明显的劣势，患糖尿病相关并发症的几率更高，如心血管疾病和终末期肾病。鉴于糖尿病及其并发症给弱势群体造成的负担不成比例，有针对性的糖尿病预防规划是公共卫生规划的一个重要组成部分。该提案是在16个研究中心进行NDPP的转化、群集随机试验，旨在招募、吸引和留住来自弱势社区的男性参与2型糖尿病预防。拟议的量身定制的方案，NDPPB，将首先在2个地点与30名男子进行试点测试，然后在纽约市5个行政区的弱势社区的8个纽约市公园和娱乐部（REC）地点实施，与8个标准NDPP REC地点进行比较。我们将与由社区领袖和学术专家组成的利益攸关方咨询小组合作，重点向目标人群开展外展活动。我们将实施以证据为基础的《国家发展政策方案》课程，并进行调整，以促进男子的更多参与。对于我们的建议，“参与”包括招聘，团体参与和保留。我们建议只有男性教练和团体成员，适应饮食信息，并加强对体育活动的重视。为了比较，标准的混合性别群体将在八个独立的REC站点实施，由纽约市自治市镇匹配，使用标准的NDPP课程。在主研究中，我们将在16个REC研究中心共招募830名受试者（18岁及以上）。拟议研究的具体目的是：1）评估与标准NDPP模型相比，NDPPB在降低BMI（主要结局）方面的有效性。我们假设，参与NDPPB的男性在16周时BMI的降低至少相当于标准NDPP中的BMI; 2）检查在弱势群体中为2型糖尿病风险男性量身定制的招募/招募，干预和保留策略的程度。 社区与改善目标人口的参与有关（次要成果）。我们假设NDPPB的实施将比标准NDPP更快地招募和招募男性; 3）确定与差异招募和干预效果相关的人口统计学、心理社会学、邻里和REC站点特征;以及4）提供NDPPB与标准社区相比的增量成本估计-基于NDPP项目的数据，并与BMI变化的主要结局相关。我们的建议的优势包括：严格的设计和分析方法，与随机的网站，参与性的方法和适应性的过程，我们的干预发展与纽约市REC网站，沿着与一个强大的社区和专家咨询小组。如果我们的假设得到支持，这项研究将为高危男性社区环境中NDPP计划的实际实施提供信息，并为减少这些人群的糖尿病负担做出重大贡献。

DESCRIPTION (provided by applicant): The rising epidemic of type 2 diabetes is a major cause of disability and death. With an estimated cost of $245 billion in 2012, diabetes also represents a significant burden to the U.S. health care system. Following the successful trial of the Diabetes Prevention Program (DPP) in 2002, the translation of this lifestyle intervention to community settings has been a major public health focus, with significant support from the CDC through the National Diabetes Prevention Program (NDPP). Although the NDPP has been shown to be effective for enrolled participants, resulting in weight loss of 5-7%, independent of setting and population group, there are striking disparities in engagement. Participation rates for men are particularly low (often <30% of a class); participation rates for Black and Latino men are even lower (<20%). Men generally have poorer health outcomes and lower life expectancies than women. Men of color, who are more likely than their white counterparts to face significant disadvantage, experience higher rates of diabetes-related complications, such as cardiovascular disease and end-stage renal disease. Given the disproportionate burden of diabetes and its complications for disadvantaged groups, targeted diabetes prevention programming is a crucial component of public health planning. This proposal is for a translational, cluster randomized trial of the NDPP in 16 sites for the main study, tailored to recruit, engage and retain men from disadvantaged communities in type 2 diabetes prevention. The proposed tailored program, the NDPPB, will first be pilot tested with 30 men in 2 sites before being implemented in 8 NYC Parks and Recreation Department (REC) sites in disadvantaged communities in each of the 5 boroughs of NYC, with 8 standard NDPP REC sites for comparison. Working in collaboration with a stakeholder Advisory Panel of community leaders and academic experts, we will conduct focused outreach to the target population. We will implement the evidence-based NDPP curriculum, with tailoring to promote increased engagement of men. For our proposal, "engagement" encompasses recruitment, group participation, and retention. We propose having male-only coaches and groups members, adaptations to the dietary messaging, and increased emphasis on physical activity. For comparison, the standard mixed-gender groups will be implemented at eight separate REC sites, matched by NYC borough, using the standard NDPP curriculum. In the main study, we will enroll a total of 830 participants (age 18 and older) across the 16 REC sites. The specific aims of the proposed study are: 1) to assess the effectiveness of the NDPPB with respect to reductions in BMI (primary outcome) compared to the standard NDPP model. We hypothesize that men engaged in the NDPPB will have reductions in BMI at 16 weeks at least equivalent to those in the standard NDPP; 2) to examine the extent to which recruitment/enrollment, intervention and retention strategies tailored for men at risk for type 2 diabetes in disadvantaged communities are associated with improved engagement of the target population (secondary outcomes). We hypothesize that implementation of the NDPPB will proceed with more rapid recruitment and enrollment of men than in the standard NDPP; 3) to identify demographic, psychosocial, neighborhood, and REC site characteristics associated with differential recruitment and intervention effects; and 4) to provide estimates of incremental costs of the NDPPB in comparison to the standard community-based NDPP programs and relative to the primary outcome of change in BMI. Strengths of our proposal include: rigorous design and analytic methodologies, with randomization by site, a participatory approach and an adaptive process for development of our intervention with the NYC REC sites, along with a strong community and expert Advisory Panel. If our hypotheses are supported, this study will inform real-world implementation of the NDPP program in community settings for high-risk men and make a significant contribution to reducing the diabetes burden in these populations.