Improving Weight Loss and Cardiometabolic Risk in Black Primary Care Patients with Obesity and Diabetes

改善患有肥胖和糖尿病的黑人初级保健患者的体重减轻和心脏代谢风险

基本信息

批准号：
10437095
负责人：
Peter Todd Katzmarzyk
金额：
$ 75.56万
依托单位：
UNIVERSITY OF ALABAMA AT BIRMINGHAM
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-24 至 2026-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10437095
关键词：
Address Adult African American Alabama American Behavioral Body Weight Body Weight decreased Body mass index Cardiometabolic Disease Caring Chronic Chronic Disease Clinic Visits Communication Computerized Medical Record Consolidated Framework for Implementation Research Continuity of Patient Care Cost Effectiveness Analysis Deep South Diabetes Mellitus Dietary intake Effectiveness Focus Groups Glycosylated hemoglobin A Goals Graph Health Health Services Accessibility Health Technology Healthcare Systems Improve Access Individual Institutes Integrated Health Care Systems Intervention Interview Level of Evidence Louisiana Low income Medical Minority Groups Mission Mississippi Modeling Non-Insulin-Dependent Diabetes Mellitus Obesity Outcome Patient Care Patient Care Team Patient Outcomes Assessments Patients Personal Communication Pharmaceutical Preparations Physical activity Population Prevention Primary Health Care Public Health Quality of life Randomized Reach, Effectiveness, Adoption, Implementation, and Maintenance Research Risk Factors Science Services Structure Technology Testing Time Translations Transportation Underserved Population United States Urban Health Videoconferencing Weight aged black patient cardiometabolic risk cardiovascular disorder risk caucasian American clinically significant collaborative care contextual factors cost effectiveness diabetes management digital digital medicine disparity reduction effective intervention effectiveness implementation study effectiveness testing evidence base experience fasting plasma glucose glycemic control health care service health disparity health equity health literacy health related quality of life hybrid type 1 study implementation intervention implementation outcomes implementation science improved individual patient innovation lifestyle intervention minority health novel strategies obese patients obesity treatment patient health information patient oriented patient portal primary care setting primary outcome programs remote delivery secondary outcome sleep quality success therapy design treatment as usual weight loss intervention weight loss program

项目摘要

PROJECT SUMMARY/ABSTRACT Type 2 diabetes is a major health concern in the United States, and underserved and minority populations share a disproportionate amount of the burden. Further, the Deep South has higher rates of obesity, diabetes, and other chronic conditions than other regions. Modest weight loss can significantly improve cardiometabolic risk and several health outcomes in patients with diabetes. This study will examine the effectiveness of integrating primary care with a health coach who remotely delivers care, facilitated by the patient portal of an electronic medical record (EMR), in Black patients with obesity and type 2 diabetes. We will also assess the contextual factors of the intervention settings that may influence utilization and dissemination of the weight loss intervention. The study group will include Black primary care patients aged 18-70 years with obesity and type 2 diabetes. We will randomly assign 352 individuals equally to an EMR-facilitated behavioral weight loss intervention and a usual care group for 24 months. Patients in the weight loss group will receive a comprehensive, high-intensity behavioral weight loss program delivered by a health coach using interactive electronic health (eHealth) technology including video conferencing, with a strong emphasis on bi-directional communication. Through an EMR patient portal, patients will have access to program materials and personalized weight loss graphs to track their progress. Patients in the usual care group will continue to receive routine medical care by their primary care practitioner. We hypothesize that patients in the weight loss group will have greater and clinically significant percent reductions in body weight compared to patients in the usual care group. We further hypothesize that patients in the weight loss group will have greater improvements in secondary outcomes, including fasting plasma glucose, hemoglobin A1c, cardiovascular disease risk factors, and patient-reported outcomes such as medication use, sleep quality, mobility, dietary intake, physical activity, and quality of life. Finally, we will study the implementation of the intervention using focus groups, semi- structured interviews, and cost-effectiveness analysis in order to better understand external validity and implementation outcomes. The proposed study will significantly advance the translation of evidence-based weight loss strategies into primary care that are widely applicable to the growing diabetes population in the United States, particularly in the Deep South.

项目摘要/摘要 2型糖尿病是美国的主要健康问题，服务不足和少数群体人口分担不成比例的负担。此外，深南部的肥胖症，糖尿病，和其他慢性条件比其他地区。体重减轻可以显着改善心脏代谢糖尿病患者的风险和几种健康结果。这项研究将检查将初级保健与远程提供护理的健康教练整合，由患者门户的促进肥胖症和2型糖尿病的黑人患者的电子病历（EMR）。我们还将评估干预设置的上下文因素可能影响减肥的利用和传播干涉。该研究组将包括18-70岁肥胖症和2型的黑人初级保健患者糖尿病。我们将平均分配352个个人为EMR的行为减肥干预和通常的护理组24个月。减肥组中的患者将接受健康教练使用Interactive提供的全面，高强度的行为减肥计划电子健康（EHealth）技术，包括视频会议，非常重视双向沟通。通过EMR患者门户，患者将可以使用程序材料和个性化的减肥图以跟踪其进度。通常的护理组中的患者将继续由其初级保健从业人员接受常规医疗保健。我们假设体重减轻的患者与患者相比通常的护理小组。我们进一步假设减肥组的患者将有更大的改善在次要结果中，包括空腹血浆葡萄糖，血红蛋白A1C，心血管疾病危险因素，以及患者报告的结果，例如使用药物使用，睡眠质量，活动能力，饮食摄入量，体育锻炼，和生活质量。最后，我们将研究使用焦点小组，半半干预的实施结构化访谈和成本效益分析，以更好地了解外部有效性和实施结果。拟议的研究将大大推动基于循证的翻译减肥策略进入初级保健，该策略广泛适用于不断增长的糖尿病人群美国，特别是在南方。