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

项目摘要 糖尿病是一种破坏性的疾病，其患病率正在增加。经常性体力活动（PA） 改善所有人的健康，包括糖尿病和糖尿病前期患者。然而，只有5%的 美国成年人足够活跃，符合美国国家指导方针。卫生部门是重要的 由于它能够接触和影响大量的人，因此它是一个促进公共权力机构的机构。短期保健 提供者PA评估和咨询可以在短期内（< 6个月）成功地提高PA，但 门诊期间的建议不足以持久改善PA。我们提议进行一次审判 Kaiser Permanente Southern加州（KPSC）的成员，这是一项具有高度种族/民族 多样性，其大多数成员是拉丁美洲人。我们将在现有的评估PA的KP创新的基础上再接再厉 在每一次门诊访问，提出一个试验，其中初级保健提供者确定的适合性， 患者增加PA，提供简短的建议，并将患者转介给PA咨询。符合条件的患者， 招募到2年，中等强度的电话行为咨询干预或常规护理。我们专注 这项试验针对的是患有糖尿病前期或糖尿病的成年人，他们因为高风险而没有服用胰岛素。 心脏代谢并发症和他们可以从常规PA中获得的巨大益处。干预， 通过动机访谈方法进行个性化，可推广到其他卫生保健提供系统。 电子病历将为次要结局提供数据。我们的长期目标是确定这种 PA干预可以成功地融入初级保健服务。如果是这样，干预可以是 因此，数百万患有糖尿病或糖尿病前期的久坐患者可以获得个人建议和PA 辅导为此，我们的主要目的是确定与常规护理相比， 在基线和24个月之间增加患者的中度至剧烈PA（通过加速度计评估） 患有2型糖尿病或前驱糖尿病。我们的次要目标是1）确定干预是否改善身体 体重指数（BMI），血红蛋白A1 C，血压，血脂和生活质量，2）决定成本- 干预的有效性。这项研究有可能对临床预防产生非常高的影响， 实践PA可以改善许多疾病和状况，但在初级保健中被严重忽视。通过 记录基于初级保健的实际干预措施的成本和影响， PA，这项研究将促进初级保健实践的重大转变。

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.