A Culturally Tailored LIfestyle Intervention to Prevent Diabetes in South Asians:

描述(由申请人提供)： 南亚人是美国人口中快速增长的一部分，他们患2型糖尿病(T2 DM)的比例明显高于普通人群，他们患T2 DM的年龄更小，一旦患有T2 DM，他们的健康状况就会比一般人差。生活方式干预有效地预防了高危人群中的2型糖尿病；南亚社区需要文化上合适的生活方式干预措施来预防糖尿病。这项试点研究的目的是：(1)为对南亚社区的社会文化规范敏感的南亚人开发一种文化上合适的生活方式干预。干预措施的设计将以焦点小组讨论的结果为基础。这项建议描述了一种基于糖尿病预防计划(DPP)生活方式协议的初步骨架生活方式干预，包括：(A)运动干预部分，旨在增加计划的灵活性和可接受性，包括课堂集体锻炼和使用DVD的家庭锻炼。健身班和DVD都包括基于适合文化的活动的练习，包括传统的民间舞蹈、瑜伽和散步，并使用南亚音乐和教练。(B)生活方式课程将以为民进党制定的课程为基础，但经过修改，侧重于营养信息和与这一人群相关的食物，重点是修改南亚饮食，以减肥、控制分量和做出健康的食物选择。(C)将成立同行支持小组，以提高对该计划的接受度和遵守程度。此次干预的设计将是低成本和可持续的。(2)在南亚社区实施文化特有的生活方式干预，作为随机对照先导研究。60名年龄在25岁或以上、患有糖尿病前期、体重指数为22公斤/平方米的南亚男性和女性将随机接受强化生活方式计划或标准生活方式建议(每组30人)。干预将持续16周，然后是8周不那么激烈的维持期，以及3个月的随访。(3)对干预措施进行评价。主要结果将是体重的变化，研究参与者被建议减掉7%的体重，并在研究过程中保持减肥。次要结果是体脂百分比、体重指数、腰臀比、空腹血糖、血压、血脂、活动量和饮食的变化。将在焦点小组讨论中评估参与者对该计划的接受程度。这项研究的最终结果将被用来开发一项更大的、明确的研究，对南亚人口中预防T2 DM的文化上合适的生活方式干预进行研究，并作为R18赠款提案提交。 与公共卫生相关：南亚共同体，即起源于印度、巴基斯坦、孟加拉国、马尔代夫、尼泊尔、斯里兰卡或不丹的人，更有可能患糖尿病，年龄较小，一旦患上糖尿病，他们的健康状况比普通人群更差。这份R34提案描述了南亚社区预防糖尿病的文化适宜的生活方式干预措施的开发、实施和评估。该项目的成果可用于规划更大规模的干预措施，以预防南亚人的糖尿病，南亚人是美国人口中快速增长的一部分。

DESCRIPTION (provided by applicant): South Asians, a rapidly growing segment of the US population, have significantly higher rates of Type 2 Diabetes Mellitus (T2DM), get T2DM at younger ages, and do worse health-wise once they have T2DM than the general population. Lifestyle interventions effectively prevent T2DM in high-risk populations; there is a need for culturally appropriate, lifestyle interventions to prevent diabetes in the South Asian community. This pilot study aims to: (1) Develop a culturally appropriate lifestyle intervention for South Asians with sensitivity to socio-cultural norms in the South Asian community. The design of the intervention will be developed based on the results of focus group discussions. This proposal describes a preliminary, skeleton lifestyle intervention based on the Diabetes Prevention Program (DPP) lifestyle protocol and including: (a) An exercise intervention component, designed to increase program flexibility and acceptability, which includes both in-class group exercise sessions and at-home exercise using a DVD. Both the exercise classes and the DVD include exercises based on culturally appropriate activities, including traditional folk dances, yoga, and walking, and use South Asian music and instructors. (b) Lifestyle classes will be based on the curricula developed for the DPP, but modified to focus on nutrition information and foods that are pertinent to this population, with a focus on modifying the South Asian diet for weight loss, portion control, and making healthy food choices. (c) Peer support groups will be formed to increase acceptability of and adherence to the program. The intervention will be designed to be low-cost and sustainable. (2) Implement the culturally specific lifestyle intervention in the South Asian community as a randomized controlled pilot study. Sixty South Asian men and women, aged 25 years or more, with prediabetes and a BMI of 22 kg/m2 will be randomized to receive either the intensive lifestyle program or standard lifestyle advice (30 individuals per group). The intervention will last for 16 weeks, followed by an 8-week less intense, maintenance period, and three months of follow-up. (3) Evaluate the intervention. The primary outcome will be change in body weight, with the study participants counseled to lose 7% body weight and maintain the weight loss over the course of the study. Secondary outcomes are changes in percent body fat, body mass index, waist-to-hip ratio, fasting glucose, blood pressure, plasma lipids, activity, and diet. The acceptability of the program to the participants will be assessed in focus group discussions. Final results of the study will be used to develop a larger, definitive study of a culturally appropriate, lifestyle intervention for the prevention of T2DM in the South Asian population to be submitted as a R18 grant proposal. PUBLIC HEALTH RELEVANCE: The South Asian Community, people with origins in India, Pakistan, Bangladesh, Maldives, Nepal, Sri Lanka, or Bhutan, are more likely to get diabetes, get diabetes at younger ages, and do worse health-wise once they have diabetes than the general population. This R34 proposal describes the development, implementation, and evaluation of a culturally appropriate lifestyle intervention for the prevention of diabetes in the South Asian community. The outcomes of this project could be used to plan larger interventions to prevent diabetes in South Asians, a rapidly growing segment of the US population.