Translating the Diabetes Prevention Program to Engage Men in Disadvantaged Areas

将糖尿病预防计划转化为弱势地区男性的参与

• 批准号: 8755373
• 负责人: ELIZABETH A. WALKER
• 金额: $ 21.2万
• 依托单位: ALBERT EINSTEIN COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-15 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8755373
• 关键词: Age; Area; Behavioral; Body Weight decreased; Cardiovascular Diseases; Centers for Disease Control and Prevention (U.S.); Cessation of life; Characteristics; Collaborations; Color; Communities; Complications of Diabetes Mellitus; Development; Diabetes Mellitus; Diabetes prevention; Diet; Disadvantaged; Eating; Educational Curriculum; Effectiveness; Employee Strikes; End stage renal failure; Enrollment; Epidemic; Face; Gender; Goals; Health; Health Planning; Healthcare Systems; Intervention; Latino; Leg; Life Expectancy; Methodology; Minority; Modeling; Neighborhoods; New York City; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Participant; Patient Self-Report; Physical activity; Population; Population Group; Process; Public Health; Randomized; Recreation; Recruitment Activity; Relative (related person); Research; Risk; Site; Target Populations; Testing; Translating; Translations; Woman; Work; base; community setting; cost; design; diabetes prevention program; disability; evidence base; experience; foot; high risk; high risk men; improved; intervention effect; lifestyle intervention; male; member; men; outreach; prevent; primary outcome; programs; psychosocial; public health relevance; randomized trial; secondary outcome

DESCRIPTION (provided by applicant): The rising epidemic of type 2 diabetes is a major cause of disability and death. With an estimated cost of $245 billion in 2012, diabetes also represents a significant burden to the U.S. health care system. Following the successful trial of the Diabetes Prevention Program (DPP) in 2002, the translation of this lifestyle intervention to community settings has been a major public health focus, with significant support from the CDC through the National Diabetes Prevention Program (NDPP). Although the NDPP has been shown to be effective for enrolled participants, resulting in weight loss of 5-7%, independent of setting and population group, there are striking disparities in engagement. Participation rates for men are particularly low (often <30% of a class); participation rates for Black and Latino men are even lower (<20%). Men generally have poorer health outcomes and lower life expectancies than women. Men of color, who are more likely than their white counterparts to face significant disadvantage, experience higher rates of diabetes-related complications, such as cardiovascular disease and end-stage renal disease. Given the disproportionate burden of diabetes and its complications for disadvantaged groups, targeted diabetes prevention programming is a crucial component of public health planning. This proposal is for a translational, cluster randomized trial of the NDPP in 16 sites for the main study, tailored to recruit, engage and retain men from disadvantaged communities in type 2 diabetes prevention. The proposed tailored program, the NDPPB, will first be pilot tested with 30 men in 2 sites before being implemented in 8 NYC Parks and Recreation Department (REC) sites in disadvantaged communities in each of the 5 boroughs of NYC, with 8 standard NDPP REC sites for comparison. Working in collaboration with a stakeholder Advisory Panel of community leaders and academic experts, we will conduct focused outreach to the target population. We will implement the evidence-based NDPP curriculum, with tailoring to promote increased engagement of men. For our proposal, "engagement" encompasses recruitment, group participation, and retention. We propose having male-only coaches and groups members, adaptations to the dietary messaging, and increased emphasis on physical activity. For comparison, the standard mixed-gender groups will be implemented at eight separate REC sites, matched by NYC borough, using the standard NDPP curriculum. In the main study, we will enroll a total of 830 participants (age 18 and older) across the 16 REC sites. The specific aims of the proposed study are: 1) to assess the effectiveness of the NDPPB with respect to reductions in BMI (primary outcome) compared to the standard NDPP model. We hypothesize that men engaged in the NDPPB will have reductions in BMI at 16 weeks at least equivalent to those in the standard NDPP; 2) to examine the extent to which recruitment/enrollment, intervention and retention strategies tailored for men at risk for type 2 diabetes in disadvantaged communities are associated with improved engagement of the target population (secondary outcomes). We hypothesize that implementation of the NDPPB will proceed with more rapid recruitment and enrollment of men than in the standard NDPP; 3) to identify demographic, psychosocial, neighborhood, and REC site characteristics associated with differential recruitment and intervention effects; and 4) to provide estimates of incremental costs of the NDPPB in comparison to the standard community-based NDPP programs and relative to the primary outcome of change in BMI. Strengths of our proposal include: rigorous design and analytic methodologies, with randomization by site, a participatory approach and an adaptive process for development of our intervention with the NYC REC sites, along with a strong community and expert Advisory Panel. If our hypotheses are supported, this study will inform real-world implementation of the NDPP program in community settings for high-risk men and make a significant contribution to reducing the diabetes burden in these populations.

描述（由申请人提供）：2型糖尿病的流行是残疾和死亡的主要原因。糖尿病在2012年估计成本为2450亿美元，也代表了美国医疗保健系统的重大负担。在2002年成功地试用了糖尿病预防计划（DPP）之后，这种生活方式干预向社区环境的翻译一直是公共卫生的主要重点，在CDC通过国家糖尿病预防计划（NDPP）的大力支持下。尽管已显示NDPP对入学参与者有效，但导致体重减轻为5-7％，独立于环境和人口组，但参与方面存在明显的差异。参与率 男人特别低（通常<班级的30％）；黑人和拉丁裔男性的参与率甚至较低（<20％）。男性通常比女性的健康状况较差，预期寿命更低。有色人种比白人对应面临重大劣势的人更有可能经历较高的糖尿病相关并发症发生率，例如心血管疾病和终末期肾脏疾病。鉴于糖尿病的负担不成比例及其对弱势群体的并发症，有针对性的糖尿病预防计划是公共卫生计划的关键组成部分。该提案是针对NDPP在16个地点进行的转化，聚类随机试验，用于量身定制的，旨在招募，参与和保留2型型糖尿病的弱势群落中的男性。拟议的量身定制计划NDPPB将首先在2个站点中与30名男子进行试验，然后在纽约市5个纽约市弱势社区中的8个纽约公园和娱乐部（REC）站点进行实施，并在8个标准NDPP REC网站中进行了8个标准的NDPP REC网站。我们将与一个社区领导者和学术专家的利益相关者咨询小组合作，我们将向目标人群进行重点宣传。我们将实施基于证据的NDPP课程，并进行裁缝以促进男性的参与度。对于我们的建议，“参与”包括招聘，团体参与和保留。我们建议拥有只有男性的教练和团体成员，适应饮食信息，并增加对体育锻炼的重视。为了进行比较，将使用标准的NDPP课程在由纽约市自治市镇匹配的八个单独的REC站点上实施标准的混合性别组。在主要研究中，我们将在16个REC站点中总共注册830名参与者（18岁以上）。拟议研究的具体目的是：1）评估NDPPB在BMI降低（主要结果）的有效性中，与标准NDPP模型相比。我们假设从事NDPPB的男性在16周时至少等于标准NDPP中的BMI降低。 2）检查针对处于弱势群体中2型糖尿病风险的男性量身定制的招聘/入学，干预和保留策略的程度 社区与目标人群的参与改善有关（次要结果）。我们假设NDPPB的实施将比在标准NDPP中更快地招募和入学人数。 3）确定与差异招募和干预效果相关的人口，社会心理，邻里和REC网站的特征； 4）与基于社区的标准NDPP计划相比，提供了NDPPB增量成本的估计，并相对于BMI变化的主要结果提供了估计。我们的建议的优势包括：严格的设计和分析方法，通过现场随机分组，参与式方法以及我们与纽约市REC网站进行干预的自适应过程以及强大的社区和专家咨询小组。如果我们的假设得到支持，这项研究将为NDPP计划的现实世界实施在社区环境中针对高风险男人而言，并为减轻这些人群的糖尿病负担做出了重大贡献。