将糖尿病预防计划生活方式干预用于减肥转化为初级保健：一项随机试验。
Translating the Diabetes Prevention Program lifestyle intervention for weight loss into primary care: a randomized trial.
机构信息
Department of Health Services Research, Palo Alto Medical Foundation Research Institute, Palo Alto, CA 94301, USA.
出版信息
JAMA Intern Med. 2013 Jan 28;173(2):113-21. doi: 10.1001/2013.jamainternmed.987.
BACKGROUND
The Diabetes Prevention Program (DPP) lifestyle intervention reduced the incidence of type 2 diabetes mellitus (DM) among high-risk adults by 58%, with weight loss as the dominant predictor. However, it has not been adequately translated into primary care.
METHODS
We evaluated 2 adapted DPP lifestyle interventions among overweight or obese adults who were recruited from 1 primary care clinic and had pre-DM and/or metabolic syndrome. Participants were randomized to (1) a coach-led group intervention (n = 79), (2) a self-directed DVD intervention (n = 81), or (3) usual care (n = 81). During a 3-month intensive intervention phase, the DPP-based behavioral weight-loss curriculum was delivered by lifestyle coach-led small groups or home-based DVD. During the maintenance phase, participants in both interventions received lifestyle change coaching and support remotely-through secure email within an electronic health record system and the American Heart Association Heart360 website for weight and physical activity goal setting and self-monitoring. The primary outcome was change in body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) from baseline to 15 months.
RESULTS
At baseline, participants had a mean (SD) age of 52.9 (10.6) years and a mean BMI of 32.0 (5.4); 47% were female; 78%, non-Hispanic white; and 17%, Asian/Pacific Islander. At month 15, the mean ± SE change in BMI from baseline was -2.2 ± 0.3 in the coach-led group vs -0.9 ± 0.3 in the usual care group (P < .001) and -1.6 ± 0.3 in the self-directed group vs usual care (P = .02). The percentages of participants who achieved the 7% DPP-based weight-loss goal were 37.0% (P = .003) and 35.9% (P = .004) in the coach-led and self-directed groups, respectively, vs 14.4% in the usual care group. Both interventions also achieved greater net improvements in waist circumference and fasting plasma glucose level.
CONCLUSION
Proven effective in a primary care setting, the 2 DPP-based lifestyle interventions are readily scalable and exportable with potential for substantial clinical and public health impact.
TRIAL REGISTRATION
clinicaltrials.gov Identifier: NCT00842426.
背景
糖尿病预防计划（DPP）生活方式干预降低了高危成年人 2 型糖尿病（DM）的发病率 58%，体重减轻是主要预测因素。然而，它尚未充分转化为初级保健。
方法
我们评估了在 1 家初级保健诊所招募的超重或肥胖成年人中进行的 2 项适应性 DPP 生活方式干预，他们患有前驱糖尿病和/或代谢综合征。参与者被随机分为（1）教练指导的小组干预组（n = 79）、（2）自我指导的 DVD 干预组（n = 81）或（3）常规护理组（n = 81）。在 3 个月的强化干预阶段，以 DPP 为基础的行为减肥课程由生活方式教练指导的小组或家庭 DVD 提供。在维持阶段，两组干预组的参与者都通过安全电子邮件在电子健康记录系统和美国心脏协会 Heart360 网站上接受生活方式改变教练指导和支持，用于体重和身体活动目标设定和自我监测。主要结局是从基线到 15 个月时体重指数（BMI）的变化（计算为体重以千克为单位除以身高以米为单位的平方）。
结果
在基线时，参与者的平均（SD）年龄为 52.9（10.6）岁，平均 BMI 为 32.0（5.4）；47%为女性；78%为非西班牙裔白人；17%为亚洲/太平洋岛民。在第 15 个月时，与常规护理组相比，教练指导组 BMI 从基线的平均变化± SE 为-2.2±0.3，而常规护理组为-0.9±0.3（P<.001），自我指导组为-1.6±0.3（P=.02）。达到 7%基于 DPP 的减肥目标的参与者百分比分别为教练指导组 37.0%（P<.001）和自我指导组 35.9%（P<.001），而常规护理组为 14.4%。两种干预措施均使腰围和空腹血糖水平得到更大的净改善。
结论
在初级保健环境中已被证明有效，这两种基于 DPP 的生活方式干预措施易于扩展和出口，具有显著的临床和公共卫生影响的潜力。
试验注册
clinicaltrials.gov 标识符：NCT00842426。
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