Kansas Center for Metabolism and Obesity REsearch (KC-MORE) - Project 3

项目3（CZYCA）：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（占美国人口的19.3%）。 疾病控制中心（CDC）的国家糖尿病预防计划（NDPP），其中包括 在6个月内至少进行16次每周核心会议。每月6次维护会议提供了框架 在美国，NDPP认可的2型糖尿病（T2D）预防计划在约28%的 美国然而，获得至少一个国家发展计划认可的方案的机会在农村明显较低（2.6%） 与城市地区相比（11.1%）。人口密度低和缺乏财政资源是一个重要的问题， 在农村地区执行和传播《国家发展计划》的障碍。国家合作研究所， 教育和推广服务，美国农业部，土地赠款 大学和县政府是实施NDPP的潜在有效但未充分利用的场所 农村居民。然而，支持NDPP生活方式干预在农村的有效性的证据 根据CDC标准定义的糖尿病前期成人，由已完成 CDC批准的培训和使用CDC建议的计划课程和会议时间表是 不可用.参加传统的面对面小组会议所需的时间和费用 这是生活在农村地区的成年人参与国家发展方案的一个重大障碍。远程学习，例如 目前已批准使用Zoom®和Facebook®等在线平台发布NDPP的群组视频 疾控中心的认可远程交付平台提供了一种潜在的具有成本效益的策略， 参与和保留，这两者都是减肥和降低糖尿病发病率的重要预测因素 在NDPP。因此，拟议的12个月，3-臂群随机非劣效性试验将比较 在项目完成时（12个月）通过Zoom®、Facebook®或FTF交付的NDPP协议的有效性。 服务于堪萨斯农村县的堪萨斯州立大学研究与推广中心（KSRE）（n = 3）将 随机分配至3个干预组之一。每个研究中心将招募15名糖尿病前期成人（NDPP 标准）居住在参与KSRE站点服务的县。KSRE工作人员将完成CDC-NDPP 培训将作为生活方式教练。主要目标将通过比较平均值来确定有效性 体重变化（kg/%）、达到≥ 5%体重减轻的百分比、PA（min/天）/达到 150 min/wk。3个干预组6个月和12个月时的目标、能量/脂肪摄入量和HbA1c。 此外，我们将通过比较参与者的招募和保留来评估干预的可行性 费率、计划参与持续时间、会议出席率、参与者与Facebook®的互动， 自我监测（饮食，PA，体重）的依从性，以及3个阶段干预交付的保真度 干预武器。

PROJECT 3 (GORCZYCA): PROJECT SUMMARY Diabetes disproportionately impacts the 60 million individuals (19.3% of the U.S. population) living in rural areas. The Center for Disease Control’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 type 2 diabetes (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%). Low population density and lack of financial resources represent significant barriers to the implementation and dissemination of the NDPP in rural areas. 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 CES staff who have completed CDC approved training and using CDC recommendations for both program curriculum and meeting schedule is unavailable. The time and expense required to travel to attend traditional face-to-face (FTF) group sessions represents a significant barrier to participation in NDPP in adults living in rural areas. Distance learning, e.g. group video using Zoom® and online platforms such as Facebook® for delivery of NDPP are 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. Therefore, the proposed 12 mo., 3-arm cluster-randomized non-inferiority trial will compare the effectiveness of the NDPP protocol delivered via Zoom®, Facebook® or FTF at program completion (12 mos.). Kansas State University Research and Extension (KSRE) sites serving rural counties in Kansas (n= 3) will be randomized to deliver one of the 3 intervention arms. Each site will recruit 15 adults with prediabetes (NDPP criteria) living in the county served by the participating KSRE site. KSRE staff who will complete CDC-NDPP training will serve as lifestyle coaches. The primary aim will determine the effectiveness by comparing mean changes in body weight (kg/%), percent achieving ≥ 5% weight loss, PA (min/day)/percent achieving the 150min/wk. goal, energy/fat intake, and HbA1c at both 6 and 12 months across the 3 intervention arms. Additionally we will assess the feasibility of the intervention by comparing participant recruitment and retention rates, duration of program participation, session attendance, participant engagement with Facebook®, compliance with self-monitoring (diet, PA, weight), and the fidelity of intervention delivery across the 3 intervention arms.