McTigue Kathleen M, Conroy Molly B, Bigi Lori, Murphy Cynthia, McNeil Melissa
The University of Pittsburgh, Department of Medicine, Pittsburgh, Pennsylvania
Diabetes Educ. 2009 Mar-Apr;35(2):199-204, 208. doi: 10.1177/0145721709332815.
To translate the Diabetes Prevention Program (DPP) lifestyle intervention into a clinical setting and evaluate its effectiveness.
The authors implemented a group-based version of the DPP lifestyle curriculum in a large academic medicine practice. It is delivered by a nurse educator over 12 weekly sessions with optional reenrollment, available on a self-pay basis, and implemented using existing clinical resources (eg, electronic medical record referrals, scheduling, conference rooms, communication technology). The program was evaluated using a controlled before-after design, including all patients referred between April 1, 2005, and February 1, 2007. Patients with a body mass index (BMI) >or=25 kg/m(2) were eligible if their primary care providers felt the program was medically appropriate and safe. Change in weight (kg) and frequency of achieving >or=7% weight loss were examined.
Referred patients were primarily female (84%), with an average age of 49.91 years (SE, 1.46) and average BMI of 39.65 kg/m(2) (SE, 0.73). Among eligible patients, 93% of enrollees and 80% of nonenrollees had follow-up weights recorded within the evaluation window. Over 1 year, mean weight change was -5.19 kg (95% confidence interval [CI], -7.71 to -2.68) among enrollees and +0.21 kg (CI, -1.0 to 1.93) among nonenrollees (P < .001). A >or=7% loss was found for 27% of enrollees and 6% of nonenrollees (P = .001).
An evidence-based lifestyle intervention can be effectively translated into the clinical setting. Use of existing resources may facilitate patient flow and minimize cost. This provider-integrated preventive care approach may provide a model for incorporating knowledge from behavioral science into clinical care.
将糖尿病预防计划（DPP）生活方式干预措施应用于临床环境并评估其效果。
作者在一个大型学术医疗实践中实施了基于小组的DPP生活方式课程。该课程由一名护士教育工作者在12周内每周授课一次，可选择重新注册，自费参加，并利用现有的临床资源（如电子病历转诊、排班、会议室、通信技术）实施。该计划采用前后对照设计进行评估，纳入了2005年4月1日至2007年2月1日期间转诊的所有患者。体重指数（BMI）≥25 kg/m²的患者，如果其初级保健提供者认为该计划在医学上合适且安全，则符合条件。检查体重变化（kg）以及体重减轻≥7%的频率。
转诊患者主要为女性（84%），平均年龄49.91岁（标准误，1.46），平均BMI为39.65 kg/m²（标准误，0.73）。在符合条件的患者中，93%的参与者和80%的非参与者在评估期内有随访体重记录。在1年多的时间里，参与者的平均体重变化为-5.19 kg（95%置信区间[CI]，-7.71至-2.68），非参与者为+0.21 kg（CI，-1.0至1.93）（P <.001）。27%的参与者和6%的非参与者体重减轻≥7%（P =.001）。
基于证据的生活方式干预措施可以有效地应用于临床环境。利用现有资源可能有助于患者流程并将成本降至最低。这种提供者整合的预防保健方法可能为将行为科学知识纳入临床护理提供一个模式。
