Impact of Augmented Care at the Worksite for Diabetes Prevention

工作场所强化护理对预防糖尿病的影响

• 批准号: 9445005
• 负责人: CARLA K MILLER
• 金额: $ 70万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-15 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9445005
• 关键词: 21 year old; Absenteeism; Adult; Awareness; Behavior Therapy; Blood Pressure; Body Weight Changes; Body Weight decreased; Body mass index; Caring; Cause of Death; Clinic; Clinical Trials; Cognitive; Consumption; Cost Effectiveness Analysis; Cost Savings; Decision Making; Diabetes Mellitus; Diabetes prevention; Diagnosis; Diet; Dietary intake; Educational Curriculum; Effectiveness of Interventions; Emotional; Employee; Equilibrium; Evaluation; Gender; Goals; Health; Health Promotion; Health system; Heterogeneity; Hyperglycemia; Intervention; Intervention Studies; Life; Life Style; Lipids; Maintenance; Mediator of activation protein; Medical; National Health and Nutrition Examination Survey; Non-Insulin-Dependent Diabetes Mellitus; Overweight; Participant; Persons; Phase; Physical activity; Population; Prediabetes syndrome; Prevalence; Preventive Intervention; Problem Solving; Public Health; Quality of life; Randomized; Recruitment Activity; Research; Risk; Risk Factors; Self Efficacy; Structure; Techniques; Training; Universities; Weight; Wellness Program; Workplace; base; cost; cost effective; cost effectiveness; design; diabetes prevention program; effective intervention; effective therapy; experience; fasting glucose; follow-up; fruits and vegetables; high risk; improved; lifestyle intervention; meetings; mindfulness; prevent; primary outcome; programs; public health intervention; response; skills; success; therapy design; translational study; treatment group

ABSTRACT In the U.S., approximately 40% of the population has some hyperglycemic condition. Worksite interventions offer a promising framework for delivering public health interventions to people with prediabetes, since worksites reach a large segment of the population for most of their adult life. The opportunity for long-term follow-up and support may be greater through worksites than through clinic-based programs. Worksite interventions that promote weight loss through lifestyle modification reduce risk for type 2 diabetes among those at high-risk. However, there is heterogeneity in the weight loss response following a standard lifestyle intervention, and early non-response to treatment is an indicator of treatment success. Stepped, or augmented, care can be effective in promoting additional weight loss among early non-responders. Furthermore, effective treatments for weight loss maintenance, especially at the worksite, are not well known. Ongoing contact and support, frequent self-weighing, and skill building in problem solving and barrier reduction offer promise as intervention strategies for weight loss maintenance. Therefore, the purpose of this study is to evaluate the impact of the standard 16-week, goal-based Group Lifestyle Balance (GLB) intervention for diabetes prevention to an alternate version of the intervention (GLB+) that is restructured with training in cognitive and emotional agency for change, problem solving, and goal attainment. University employees who are at least 21 years old with prediabetes (n=236) will be recruited and receive the first 4 weeks of the standard GLB intervention. Participants who fail to achieve 2.5% weight loss at intervention week 5 will receive the GLB+ intervention for the remaining 12 weeks. The 16-week core intervention phase then will be followed by an 8-month extended intervention phase to promote weight loss maintenance. Following the core intervention phase, matched pairs of participants will be created based on gender and percent weight change from baseline. Each person in the pair will be randomly assigned to either the extended intervention phase of the standard GLB intervention or to the extended intervention phase of the GLB+ intervention. A 6-month no contact maintenance phase will follow the extended intervention phase. The impact of the interventions on percent change in weight (primary outcome), fasting glucose, lipid panel, blood pressure, dietary intake, physical activity, quality of life, and constructs related to problem solving and goal setting will be determined at 4, 12, and 18 months. Cost effectiveness analysis also will be conducted to determine if the benefits associated with weight change justify the costs associated with intervention augmentation. The proposed study will enable evaluation of a practical approach for a sustainable diabetes prevention program at a university worksite and the impact of augmented care on early non-response to treatment and on weight loss maintenance.

抽象的 在美国，大约40％的人口具有一定的高血糖状况。工作场所干预 为糖尿病前患者提供公共卫生干预措施，提供有前途的框架，因为 在成年后的大部分时间里，工作人员都达到了大部分人口。长期的机会 通过工作地点，随访和支持可能比通过基于诊所的计划更大。工作场所 通过改变生活方式来促进体重减轻的干预措施降低了2型糖尿病风险 那些处于高风险的人。但是，在标准生活方式之后，减肥反应有异质性 干预和对治疗的早期无反应是治疗成功的指标。走了 增强，护理可以有效地促进早期非反应者之间的额外体重减轻。 此外，尤其是在工作场所，尤其是在工作场所的有效治疗方法，尚不清楚。 持续的接触和支持，频繁的自我投资以及解决问题和障碍的技能建设 提供承诺作为减肥维持的干预策略。因此，这项研究的目的是 评估标准16周，基于目标的团体生活方式平衡（GLB）干预的影响 预防糖尿病到替代版本的干预措施（GLB+），该版本通过培训进行了重组 认知和情感机构的变化，解决问题和目标。大学员工 将招募至少21岁的患有糖尿病前（n = 236）的年龄（n = 236）并接受 标准GLB干预。在干预第5周未能实现2.5％体重减轻的参与者将 在剩余的12周内接受GLB+干预措施。然后是16周的核心干预阶段 然后是8个月的扩展干预阶段，以促进减肥维持。遵循核心 干预阶段，将根据性别和体重变化百分比创建匹配的参与者对 从基线。这对夫妇中的每个人将被随机分配给 标准GLB干预或GLB+干预的扩展干预阶段。 6个月号 接触维护阶段将遵循扩展干预阶段。干预措施对 体重变化百分比（主要结果），空腹葡萄糖，脂质面板，血压，饮食摄入量， 将在 4、12和18个月。还将进行成本效益分析以确定收益是否 与体重变化相关，证明与干预措施相关的成本是合理的。提议 研究将对可持续糖尿病预防计划的实用方法进行评估 大学工作场所以及增强护理对早期无反应治疗和减肥的影响 维护。