The National Diabetes Prevention Program in Rural Communities

国家农村社区糖尿病预防计划

基本信息

批准号：
10737009
负责人：
Anna Michael Gorczyca
金额：
$ 71.94万
依托单位：
UNIVERSITY OF KANSAS MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-15 至 2028-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10737009
关键词：
Address Adult Advertising Age Agriculture Body Weight Body Weight Changes Body Weight decreased Centers for Disease Control and Prevention (U.S.)Clinic Collaborations Control Groups County County Government Development Diabetes Mellitus Distance Learning Education Educational Curriculum Effectiveness Effectiveness of Interventions Electronic Health Record Electronic Mail Eligibility Determination Enrollment Ethnic Origin Fatty acid glycerol esters Food Frequencies Funding Glycosylated hemoglobin A Goals Grant Hemoglobin A Improve Access Incidence Income Individual Intake Intervention Interview Kansas Life Style Maintenance Mediator Methods Minority Groups Monitor Non-Insulin-Dependent Diabetes Mellitus Participant Patient Recruitments Physical activity Population Practical Robust Implementation and Sustainability Model Prediabetes syndrome Prevalence Prevention Prevention program Program Sustainability Protocols documentation Race Randomized Recommendation Recruitment Activity Research Rural Rural Community Schedule Self Direction Services Site Structure Techniques Time Training Universities Weight Gain arm compare effectiveness comparison intervention cost cost comparison cost effective cost effectiveness demographics diabetes prevention program effectiveness evaluation effectiveness/implementation trial evidence base high risk improved information gathering intervention cost intervention delivery intervention participants lifestyle intervention male meetings prevent primary outcome programs recruit remote delivery rural area rural counties rural dwellers rural health clinic secondary outcome sex treatment arm underserved rural area urban area weight loss program

项目摘要

PROJECT SUMMARY Diabetes disproportionately impacts the 60 million individuals living in rural areas where the prevalence of Type 2 diabetes (T2D) is ~17% higher than in urban areas. The Centers for Disease Control and Prevention’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 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%). 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 Cooperative Extension staff who have completed CDC approved training and using CDC recommendations for both program curriculum and meeting schedule is unavailable. Distance learning, e.g., group video using Zoom®, for delivery of NDPP is 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. The proposed 12-mo. Type II hybrid effectiveness- implementation trial will compare the effectiveness of the NDPP protocol delivered via distance learning by agents associated with Kansas State Research and Extension (KSRE) serving as a lifestyle coach (GV-NDPP) vs. a self-directed control arm (SD-NDPP) which will receive the NDPP curriculum on the same schedule used for the GV-NDPP arm delivered to individual participants via an iPad® with available lifestyle coach support. Ten KSRE local units/districts serving rural Kansas counties will be allocated to either active (n=5) or passive recruitment (n=5). Active recruitment will form collaborations with rural health clinics to identify potential participants using clinic electronic health records. Passive recruitment will use traditional recruitment techniques, e.g., flyers, email list serves, media advertising etc. Each of the 10 sites will recruit 16 adults with prediabetes defined using current NDPP criteria living in the county served by KSRE (n=160) who will be randomized (1:1) to one of the 2 intervention arms. Aim 1 will compare weight change between the GV-NDPP and SD-NDPP arms across 12 mos. Secondarily, we will compare the proportion of participants meeting CDC weight loss (≥5%) and physical activity goals (≥150 min./wk.), and changes in hemoglobin A1c across 12 mos. between intervention arms. Aim 2 will compare the effectiveness of passive and active recruitment. Aim 3 will compare the cost and cost effectiveness of delivery (GV-NDPP vs. SD-NDPP) and recruitment (passive vs. active) methods.

项目摘要糖尿病不成比例地影响居住在农村地区的6000万个人 2种糖尿病（T2D）比城市地区高约17％。疾病控制与预防中心（CDC）国家糖尿病预防计划（NDPP），其中包括至少16次每周16次核心会议 mos。和6个每月维护会议为预防T2D提供了框架 NDPP公认的计划在约28％的美国县提供；但是，访问至少1个NDPP 与城市地区相比，农村地区公认的计划明显降低（2.6％）（11.1％）。合作社国家研究，教育和推广服务，美国农业部之间的合作伙伴关系，土地授予大学和县政府代表了一个潜在的有效但未充分利用的地点将NDPP交付给粗糙的居民。但是，支持NDPP生活方式的有效性的证据干预由CDC标准定义的农村成年人的干预，并进行干预。已完成CDC批准培训并使用CDC建议的合作推广人员课程课程和会议时间表都不可用。远程学习，例如，使用 Zoom®，用于交付NDPP的目前已批准用于CDC识别。远程交付平台提供改善参与和保留的潜在具有成本效益的策略，这都是重要的预测指标体重减轻和NDPP糖尿病发病率降低。提议的12-MO。 II型混合有效性 - 实施试验将比较通过远程学习提供的NDPP协议的有效性与堪萨斯州立研究与扩展（KSRE）相关的代理商，担任生活方式教练（GV-NDPP）与自我指导的控制臂（SD-NDPP），该控制臂将按照相同的时间表接受NDPP课程对于通过iPad®送给单个参与者的GV-NDPP臂，并提供了可用的生活方式教练支持。为堪萨斯州农村县服务的十千千克地区/地区将分配给活跃（n = 5）或被动招聘（n = 5）。积极招聘将与粗糙的健康诊所合作，以确定潜力参与者使用诊所电子健康记录。被动招聘将使用传统招聘技术，例如传单，电子邮件列表服务，媒体广告等。这10个网站中的每个网站都将招募16名成年人使用KSRE（n = 160）在该县居住的当前NDPP标准定义的糖尿病前期随机（1：1）到两个干预臂之一。 AIM 1将比较GV-NDPP之间的体重变化和SD-NDPP的武器横穿12个月。其次，我们将比较与CDC遇到的参与者的比例体重减轻（≥5％）和体育锻炼目标（≥150min./wk。），以及12个MOS的血红蛋白A1C的变化。在干预臂之间。 AIM 2将比较被动和主动招募的有效性。目标3意志比较交付的成本和成本效益（GV-NDPP与SD-NDPP）和招聘（被动与招聘活性）方法。