Intervention based in primary care to increase physical activity among inactive adults with prediabetes and diabetes

项目总结 糖尿病是一种破坏性的疾病，其患病率正在上升。有规律的体力活动(PA)显著 改善所有人的健康，包括那些患有糖尿病和糖尿病前期的人。然而，只有5%的人 美国成年人足够活跃，足以满足美国的国家指导方针。卫生部门是一个重要的 设置推广PA，因为它有能力接触和影响大量的人。简明的医疗保健 提供者PA评估和咨询可以在短期内(&lt；6个月)成功增加PA，但是 门诊期间的建议不足以持续改善PA。我们建议进行一项试验，包括 南加州凯撒永久健康计划(KPSC)的成员，这是一个种族/民族较高的综合健康计划 其成员主要是拉丁裔。我们将建立在评估PA的现有KP创新的基础上 在每次门诊时，建议进行一项试验，由初级保健提供者确定 患者增加PA，提供简短的建议，并转介患者进行PA咨询。符合条件的患者将在 被招募到为期2年的中等强度电话行为咨询干预或常规护理。我们专注于 这项试验针对的是患有糖尿病前期或糖尿病的成年人，因为他们的高风险而没有开出胰岛素处方 对于心脏代谢并发症和他们可以从常规PA中获得的巨大好处。干预， 通过激励性访谈方法进行个体化，可推广到其他保健服务提供系统。 电子病历将提供次要结果的数据。我们的长期目标是确定这样的情况 PA干预可以成功地融入初级保健服务。如果是这样的话，干预可以是 扩大规模，使数百万久坐不动的糖尿病或糖尿病前期患者可以接受个人建议和PA 心理咨询。为此，我们的主要目标是确定研究干预是否与通常的护理相比， 在基线到24个月之间增加患者的中度到剧烈的PA(通过加速度计评估) 患有2型糖尿病或糖尿病前期患者。我们的次要目标是1)确定干预是否能改善身体状况 体重指数(BMI)、血红蛋白A1C、血压、血脂和生活质量，以及2)决定成本- 干预措施的有效性。这项研究有可能对临床预防产生很大的影响。 练习。PA改善了许多疾病和状况，在初级保健中被严重忽视。通过 记录以初级保健为基础的实际干预措施的成本和效果 PA，这项研究将促进初级保健实践中非常重要的转变。

PROJECT SUMMARY Diabetes is a devastating disease that is increasing in prevalence. Regular physical activity (PA) markedly improves health for all individuals, including those with diabetes and prediabetes. However, only 5% of American adults are sufficiently active to meet U.S. national guidelines. The health sector is an important setting to promote PA because of its ability to reach and influence large numbers of people. Brief health care provider PA assessment and counseling can successfully increase PA in the short-term (< 6 months), but advice during an outpatient visit is insufficient for lasting PA improvements. We propose a trial including members of Kaiser Permanente Southern California (KPSC), an integrated health plan with high racial/ethnic diversity and whose majority membership is Latino. We will build on an existing KP innovation of assessing PA at every outpatient visit by proposing a trial in which the primary care provider determines the suitability of a patient to increase PA, provides brief advice, and refers patients for PA counseling. Eligible patients are then recruited to a 2-year, medium-intensity telephone behavioral counseling intervention or usual care. We focus the trial on adults who have prediabetes or diabetes who are not prescribed insulin because of their high risk for cardiometabolic complications and the great benefit they can obtain from regular PA. The intervention, individualized by the motivational interviewing approach, is generalizable to other health care delivery systems. Electronic medical records will provide data for secondary outcomes. Our long-term goal is to determine if such a PA intervention can be successfully integrated into primary care services. If so, the intervention can be scaled so millions of sedentary patients with diabetes or prediabetes can receive personal advice and PA counseling. To this end, our primary aim is to determine if the study intervention, compared with usual care, increases moderate-to-vigorous PA (assessed by accelerometry) between baseline and 24 months in patients with type 2 diabetes or prediabetes. Our secondary aims are to 1) determine if the intervention improves body mass index (BMI), hemoglobin A1C, blood pressure, lipids, and quality of life, and 2) determine the cost- effectiveness of the intervention. This study has the potential for a very high impact on clinical preventive practices. PA improves numerous diseases and conditions and is seriously neglected in primary care. By documenting the costs and effects of a practical intervention based in primary care on an objective measure of PA, this study will promote a highly significant shift in primary care practice.