Using Virtual Environments to Improve Health and Compliance in Diabetes

描述（由申请人提供）：本申请涉及广泛的挑战领域（05）：比较有效性研究和特定挑战主题05- lm -104*“虚拟现实”互动在改善糖尿病治疗依从性中的价值。糖尿病已成为严重的公共卫生问题。根据美国糖尿病协会的数据，2100万美国人患有糖尿病，其中95%是2型糖尿病（美国糖尿病协会医疗保健标准，2008）。展望计划（展望，2007年）是一项干预措施，已被证明对2型糖尿病成人患者的减肥、增加体育活动和改善代谢因素有效。然而，“展望未来”计划尚未有效地转化为护理。像“展望”这样的项目翻译的主要障碍是这些干预措施有效所需的扩展临床接触。由于缺乏时间和办公系统的限制，密集干预在初级保健中往往是不可行的，而其他健康促进计划（如员工健康）往往由于其前期费用而不采用此类计划。因此，为向心血管疾病和死亡风险高的糖尿病患者和员工提供有效干预措施创造新方法显然是一项挑战。提出的研究旨在通过开发虚拟展望计划（VLAP）将展望（LA）密集生活方式干预转化为员工健康计划。VLAP将(1)与糖尿病患者互动，创建一个初步的治疗计划，然后在与他们的研究医生的访问中批准，(2)提供持续的基于洛杉矶的营养和身体活动咨询，根据需要，24/7，从任何连接互联网的计算机和具有浏览器功能的移动设备，(3)收集患者依从性，健康和动机的数据。由于VLAP将通过互联网设备开发，定制治疗计划的有效性和安全性将在研究员工医疗保健从业人员（如营养师、护士、执业护士或医师助理）的每月办公室访问中进行监测。拟议的试点研究将在一项小型随机比较有效性试点中测试VLAP的初始使用，该试点从纽约州罗切斯特的两家大型自保险雇主中招募员工，比较第1组VLAP +研究从业者（N=35）与第2组标准糖尿病支持和教育+研究从业者（N=35）在6个月内将体重减轻7%的LA目标。该项目将创建一个电子体育活动顾问和营养师，与患有糖尿病的员工讨论健康行为（体育活动，营养），并帮助员工制定减肥和增加体育活动的计划，以降低患心脏病的风险。

DESCRIPTION (provided by applicant): This application addresses broad Challenge Area (05): Comparative Effectiveness Research and Specific Challenge topic 05-LM-104* Value of "Virtual Reality" Interaction in Improving Compliance with Diabetic Regimen. Diabetes has become a serious public health problem. According to data from the American Diabetes Association, 21 million Americans have diabetes, and 95% of those cases are Type 2 (ADA Standards of Medical Care in Diabetes, 2008). The Look AHEAD Program (Look AHEAD, 2007) is one intervention that has proven efficacious in reducing weight, increasing physical activity, and improving metabolic factors in adults with type-2 diabetes. However, the Look AHEAD Program has not yet been effectively translated into care. The major barrier to translation for programs like Look AHEAD is the extended clinical contact required for these interventions to be efficacious. Intensive interventions often are not feasible within primary care due to lack of time and constraints on office systems, and other health-promotion programs (e.g., employee wellness) often do not adopt such programs because of their up-front costs. Thus, there is a clear challenge to create new methods for delivering effective interventions to the population of patients and employees with diabetes who are at high risk for cardiovascular disease and death. The proposed research seeks to translate the Look AHEAD (LA) intensive lifestyle intervention into employee health programs through the development of a Virtual Look AHEAD Program (VLAP). The VLAP will (1) interact with the diabetic patient to create a preliminary treatment plan that is then approved in a visit with their study practitioner, (2) provide ongoing LA-based nutrition and physical activity counseling that is available on demand, 24/7 from any Internet-connected computer and browser-capable mobile device, and (3) collect data on patient adherence, health, and motivation. Because the VLAP will be developed to be available through Internet devices, customized treatment plans will be monitored for effectiveness and safety in a monthly office visit with the study employee health care practitioner (e.g., nutritionist, nurse, nurse practitioner, or physician assistant). The proposed pilot study will test the initial use of the VLAP in a small randomized comparative effectiveness pilot in employees recruited from two large self-insured employers in Rochester, New York comparing Group 1 VLAP + study practitioner (N=35) vs. Group 2 Standard Diabetes Support and Education + study practitioner (N=35) in reducing weight to LA goal of 7% loss over 6 months. This project will create an electronic physical activity counselor, and nutritionist that will discuss healthy behaviors (physical activity, nutrition) with employees with diabetes and help employees build a plan for weight loss and increased physical activity to reduce their risk for heart disease.