The National Diabetes Prevention Program in Rural Communities

项目摘要 糖尿病不成比例地影响着生活在农村地区的6000万人， 2型糖尿病（T2 D）比城市地区高约17%。美国疾病控制和预防中心（CDC） 国家糖尿病预防计划（NDPP），其中包括至少16个每周核心会议超过6 莫斯和6个月的维护会议提供了预防T2 D在美国的框架。 NDPP认可的计划在美国约28%的县提供;但是，获得至少1个NDPP 与城市地区（11.1%）相比，农村地区（2.6%）获得认可的方案明显较少。合作社 国家研究，教育和推广服务，美国农业部， 赠地大学和县政府代表了一个潜在的有效，但未充分利用的网站， 向农村居民提供NDPP。然而，支持NDPP生活方式有效性的证据 对根据CDC标准定义的农村糖尿病前期成人进行干预， 已完成CDC批准的培训并使用CDC建议的合作推广人员， 课程安排和会议时间表都不可用。远程学习，例如，群组视频使用 用于递送NDPP的Zoom®目前已获得CDC认可。远程交付平台提供了 提高参与率和保留率的潜在成本效益战略，这两者都是重要的预测因素 体重减轻和糖尿病发病率降低。建议的12个月。第二类混合效应- 实施试验将比较通过远程学习提供的NDPP协议的有效性， 与堪萨斯州研究和推广（KSRE）相关的代理人担任生活方式教练（GV-NDPP） vs.一个自我导向控制臂（SD-NDPP），它将在使用的相同时间表上接收NDPP课程 GV-NDPP组通过iPad®提供给个体参与者，并提供生活方式教练支持。 为堪萨斯农村县服务的10个KSRE地方单位/地区将被分配到主动（n=5）或被动 招募（n=5）。积极招募将与农村卫生诊所合作，以确定潜在的 使用诊所电子健康记录的参与者。被动招聘将采用传统招聘方式 技术，例如，传单，电子邮件列表服务，媒体广告等10个网站将招募16名成年人， 使用当前NDPP标准定义的糖尿病前期，居住在KSRE服务的县（n=160）， 随机（1：1）分配至2个干预组之一。目标1将比较GV-NDPP之间的重量变化 和SD-NDPP臂跨越12 mos。其次，我们会比较符合CDC的参与者比例， 体重减轻（≥5%）和体力活动目标（≥150分钟/ wk.），以及12个月内血红蛋白A1 c的变化。 干预武器之间。目标2将比较被动和主动招募的有效性。目标3将 比较交付（GV-NDPP vs. SD-NDPP）和招募（被动vs. 主动）方法。

PROJECT SUMMARY Diabetes disproportionately impacts the 60 million individuals living in rural areas where the prevalence of Type 2 diabetes (T2D) is ~17% higher than in urban areas. The Centers for Disease Control and Prevention’s (CDC) National Diabetes Prevention Program (NDPP) which includes a minimum of 16 weekly core sessions over 6 mos. and 6 monthly maintenance sessions provides the framework for the prevention of T2D in the U.S. NDPP recognized programs are available in ~28% of U.S. counties; however, access to at least 1 NDPP recognized program is significantly lower in rural (2.6%) compared with urban areas (11.1%). The Cooperative State Research, Education and Extension Service, a partnership between the U.S Department of Agriculture, land-grant universities and county governments represents a potentially effective but underutilized site for delivery of NDPP to rural residents. However, evidence to support the effectiveness of the NDPP lifestyle intervention in rural adults with prediabetes defined by CDC criteria, with the intervention delivered by Cooperative Extension staff who have completed CDC approved training and using CDC recommendations for both program curriculum and meeting schedule is unavailable. Distance learning, e.g., group video using Zoom®, for delivery of NDPP is currently approved for CDC recognition. Remote delivery platforms provide a potentially cost-effective strategy for improving participation and retention, which are both important predictors of weight loss and reduced diabetes incidence in NDPP. The proposed 12-mo. Type II hybrid effectiveness- implementation trial will compare the effectiveness of the NDPP protocol delivered via distance learning by agents associated with Kansas State Research and Extension (KSRE) serving as a lifestyle coach (GV-NDPP) vs. a self-directed control arm (SD-NDPP) which will receive the NDPP curriculum on the same schedule used for the GV-NDPP arm delivered to individual participants via an iPad® with available lifestyle coach support. Ten KSRE local units/districts serving rural Kansas counties will be allocated to either active (n=5) or passive recruitment (n=5). Active recruitment will form collaborations with rural health clinics to identify potential participants using clinic electronic health records. Passive recruitment will use traditional recruitment techniques, e.g., flyers, email list serves, media advertising etc. Each of the 10 sites will recruit 16 adults with prediabetes defined using current NDPP criteria living in the county served by KSRE (n=160) who will be randomized (1:1) to one of the 2 intervention arms. Aim 1 will compare weight change between the GV-NDPP and SD-NDPP arms across 12 mos. Secondarily, we will compare the proportion of participants meeting CDC weight loss (≥5%) and physical activity goals (≥150 min./wk.), and changes in hemoglobin A1c across 12 mos. between intervention arms. Aim 2 will compare the effectiveness of passive and active recruitment. Aim 3 will compare the cost and cost effectiveness of delivery (GV-NDPP vs. SD-NDPP) and recruitment (passive vs. active) methods.