Section of Preventive Medicine and Epidemiology, Boston University/Boston Medical Center, Boston, MA, USA.
Data Coordinating Center, Boston University School of Public Health, Boston University/Boston Medical Center, Boston, MA, USA.
Prev Med Rep. 2016 May 21;4:107-12. doi: 10.1016/j.pmedr.2016.05.012. eCollection 2016 Dec.
Lifestyle behavior changes can prevent progression of prediabetes to diabetes but providers often are not able to effectively counsel about preventive lifestyle changes. We developed and pilot tested the Avoiding Diabetes Thru Action Plan Targeting (ADAPT) program to enhance primary care providers' counseling about behavior change for patients with prediabetes. Primary care providers in two urban academic practices and their patients with prediabetes were recruited to participate in the ADAPT study, an unblinded randomized pragmatic trial to test the effectiveness of the ADAPT program, including a streamlined electronic medical record-based goal setting tool. Providers were randomized to intervention or control arms; eligible patients whose providers were in the intervention arm received the ADAPT program. Physical activity (the primary outcome) was measured using pedometers, and data were gathered about patients' diet, weight and glycemic control. A total of 54 patients were randomized and analyzed as part of the 6-month ADAPT study (2010-2012, New York, NY). Those in the intervention group showed an increase total daily steps compared to those in the control group (+ 1418 vs - 598, p = 0.007) at 6 months. There was also a trend towards weight loss in the intervention compared to the control group (- 1.0 lbs. vs. 3.0 lbs., p = 0.11), although no change in glycemic control. The ADAPT study is among the first to use standard electronic medical record tools to embed goal setting into realistic primary care workflows and to demonstrate a significant improvement in prediabetes patients' physical activity.
生活方式行为的改变可以预防糖尿病前期进展为糖尿病，但提供者通常无法有效地就预防生活方式的改变提供建议。我们开发并试点测试了“通过针对计划的行动避免糖尿病（ADAPT）”计划，以增强初级保健提供者对糖尿病前期患者进行行为改变的建议。两家城市学术实践中的初级保健提供者及其糖尿病前期患者被招募参与 ADAPT 研究，这是一项非盲随机实用试验，旨在测试 ADAPT 计划的有效性，包括简化的基于电子病历的目标设定工具。提供者被随机分配到干预组或对照组；符合条件的患者，如果他们的提供者在干预组，则接受 ADAPT 计划。使用计步器测量身体活动（主要结果），并收集有关患者饮食、体重和血糖控制的数据。共有 54 名患者随机分组并参与了为期 6 个月的 ADAPT 研究（2010-2012 年，纽约州纽约市）。与对照组相比，干预组的患者在 6 个月时总每日步数增加（+1418 比 -598，p=0.007）。与对照组相比，干预组的体重也有下降趋势（-1.0 磅比 3.0 磅，p=0.11），尽管血糖控制没有变化。ADAPT 研究是首批使用标准电子病历工具将目标设定嵌入现实初级保健工作流程的研究之一，并证明了糖尿病前期患者身体活动的显著改善。
