Reducing cardiometabolic risk and promoting functional health in community-based elders with obesity and pre-diabetes: evaluating sustainable DPP follow-up strategies

摘要 老年人肥胖和糖尿病前期的融合大大增加了患糖尿病的风险，而且 加速功能衰退、多发病、残疾和死亡。需要更多的研究来提炼和完善 扩大预防干预，减轻老年人和社会负担。十多年来，有效的6-和 成功地将为期12个月的糖尿病预防计划(DPP)生活方式干预措施转化为 显示出积极的影响。然而，开发和评估潜在可扩展计划的努力 符合当前长期民进党干预的指导方针(最多24个月)，并帮助更大 达到并维持推荐的≥减重目标的参与者比例不足5%。我们的 科学前提是对翻译性民进党干预的评估，主要集中在 减肥诱导策略必须扩展到包括更长期的干预措施， 展示持久的体重、心脏代谢和功能健康益处，特别是对脆弱的老年人 基于社区的设置。我们之前基于DPP的研究已经记录了电话跟踪的效用- 在为期6个月的DPP减肥诱导后上升，并显示63%的65-80岁志愿者样本中 肥胖和其他危险因素能够在12个月后维持≥5%的体重下降。尽管有很好的证据表明 持续时间更长的生活方式干预会产生更好的结果(反映在最新的医疗保险裁决中) 对老年人进行为期24个月的DPP干预的翻译性研究。我们现在建议利用 以社区为基础的设置，以检查我们是否能够维持以老年人为重点的民进党方法的影响 在24个月的时间内使用可能可扩展的治疗组件。我们将在65-80年内招募和招生 来自老年社区中心网络的肥胖和糖尿病前期老年人(N=360)，这些中心提供 老龄化服务。干预计划的顺序将与当前的联邦医疗保险政策保持一致。首先，从0- 6个月，经验丰富的生活方式教练将实施DPP-视频干预，主要由 为所有参与者提供电话辅导，至少25%来自少数民族/种族少数群体。接下来，参赛者将 随机(每组N=180人；按体重下降或≥5%分层)到两个18个月的随访中的一个 条件在6-24个月之间进行。我们将比较(1)民进党持续(民进党-S)和 (2)12个月、18个月和24个月时体重/肥胖度(主要结果)的最小DPP(DPP-M)。在……里面 此外，我们将收集心脏代谢、体力活动、身体功能、心理社会、行为和其他方面的信息 对年龄敏感的生活质量在12、18和24个月时进行测量。还将检查联邦医疗保险索赔数据 对于样本中有关用药、门诊、住院和急诊的比例，以及 注册/参与以老年人为重点的活动方案。这项工作，如果成功，将立即 基于DPP的生活方式干预的潜力，这与慢性护理模式一致，并将受益 脆弱的老年个人和社会。

ABSTRACT The confluence of obesity and pre-diabetes in older adults substantially increases the risk of diabetes, and accelerates functional decline, multimorbidity, disability, and death. More research is needed to refine and extend preventive interventions to reduce burden for elders and society. For over a decade efficacious 6- and 12-month Diabetes Prevention Program (DPP) lifestyle interventions have been translated successfully and demonstrated positive impact. However, efforts to develop and evaluate potentially scalable programs conforming to current guidelines for longer term DPP interventions (up to 24 months) and help a greater proportion of enrollees achieve and sustain the recommended weight loss target of ≥ 5% are lacking. Our scientific premise is that the evaluation of translational DPP interventions, which has centered largely on strategies for weight loss induction, must be extended to include longer-term interventions that clearly demonstrate durable weight, cardiometabolic and functional health benefits especially for vulnerable elders in community-based settings. Our previous DPP-based research has documented the utility of telephone follow- up after a 6-month DPP weight loss induction and shown that 63% of a 65-80 year old volunteer sample with obesity and other risk factors were able to sustain ≥ 5% weight loss at 12-months. Despite good evidence that longer duration lifestyle interventions yield better outcomes (reflected in the latest Medicare ruling) there are no translational studies of 24-month long DPP interventions with older adults. We now propose to utilize community based settings to examine whether we can sustain the impact of an elder-focused DPP approach using potentially scalable treatment components over a 24-month period. We will recruit and enroll 65-80 year old adults with obesity and pre-diabetes (N = 360) from a network of senior community centers that provide aging services. The intervention program sequencing will be aligned with current Medicare policy. First, from 0- 6 months, experienced lifestyle coaches will administer a DPP-video intervention anchored primarily by telephone coaching for all participants, at least 25% from ethnic/racial minority groups. Next, participants, will be randomized (N = 180 per arm; stratified by weight loss of < or ≥ 5%) to one of two 18-month follow-up conditions conducted between 6-24 months. We will compare the effects of (1) DPP-Sustained (DPP-S) and (2) DPP-Minimal (DPP-M) on measures of weight/adiposity (the primary outcome) at 12, 18, and 24 months. In addition, we will collect cardiometabolic, physical activity, physical function, psychosocial, behavioral and other age-sensitive quality of life measures at 12 and 18 and 24 months. Medicare claims data will also be examined for a proportion of the sample regarding medication use, outpatient, inpatient, and emergency visits and enrollment/participation in elder-focused activity programs. This work, if successful, will have immediate potential for DPP-based lifestyle interventions, which are consistent with a chronic care model, and will benefit vulnerable aging individuals and society.