退伍军人健康管理局的糖尿病预防计划翻译
Diabetes Prevention Program Translation in the Veterans Health Administration.
作者信息
Moin Tannaz, Damschroder Laura J, AuYoung Mona, Maciejewski Matthew L, Datta Santanu K, Weinreb Jane E, Steinle Nanette I, Billington Charles, Hughes Maria, Makki Fatima, Holleman Robert G, Kim H Myra, Jeffreys Amy S, Kinsinger Linda S, Burns Jennifer A, Richardson Caroline R
机构信息
Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California; VA Health Services Research and Development (HSR&D) Center for Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles, California.
Ann Arbor VA Center for Clinical Management Research, Ann Arbor, Michigan.
出版信息
Am J Prev Med. 2017 Jul;53(1):70-77. doi: 10.1016/j.amepre.2016.11.009. Epub 2017 Jan 13.
INTRODUCTION
This clinical demonstration trial compared the effectiveness of the Veterans Affairs Diabetes Prevention Program (VA-DPP) with an evidence-based usual care weight management program (MOVE!) in the Veterans Health Administration health system.
DESIGN
Prospective, pragmatic, non-randomized comparative effectiveness study of two behavioral weight management interventions.
SETTING/PARTICIPANTS: Obese/overweight Veterans with prediabetes were recruited from three geographically diverse VA sites between 2012 and 2014.
INTERVENTION
VA-DPP included 22 group-based intensive lifestyle change sessions.
MAIN OUTCOME MEASURES
Weight change at 6 and 12 months, hemoglobin A1c (HbA1c) at 12 months, and VA health expenditure changes at 15 months were assessed using VA electronic health record and claims data. Between- and within-group comparisons for weight and HbA1c were done using linear mixed-effects models controlling for age, gender, race/ethnicity, baseline outcome values, and site. Analyses were conducted in 2015-2016.
RESULTS
A total of 387 participants enrolled (273 VA-DPP, 114 MOVE!). More VA-DPP participants completed at least one (73.3% VA-DPP vs 57.5% MOVE! p=0.002); four (57.5% VA-DPP vs 42.5% MOVE!, p=0.007); and eight or more sessions (42.5% VA-DPP vs 31% MOVE!, p=0.035). Weight loss from baseline was significant at both 6 (p<0.001) and 12 months (p<0.001) for VA-DPP participants, but only significant at 6 months for MOVE! participants (p=0.004). Between groups, there were significant differences in 6-month weight loss (-4.1 kg VA-DPP vs -1.9 kg MOVE!, p<0.001), but not 12-month weight loss (-3.4 kg VA-DPP vs -2.0 kg MOVE!, p=0.16). There were no significant differences in HbA1c change or outpatient, inpatient, and total VA expenditures.
CONCLUSIONS
VA-DPP participants had higher participation rates and weight loss at 6 months, but similar weight, HbA1c, and health expenditures at 12 months compared to MOVE!
PARTICIPANTS
Features of VA-DPP may help enhance the capability of MOVE! to reach a larger proportion of the served population and promote individual-level weight maintenance.
引言
本临床示范试验在退伍军人健康管理局医疗系统中，比较了退伍军人事务部糖尿病预防计划（VA-DPP）与基于循证的常规护理体重管理计划（MOVE!）的有效性。
设计
对两种行为体重管理干预措施进行前瞻性、实用性、非随机对照有效性研究。
地点/参与者：2012年至2014年期间，从三个地理位置不同的退伍军人事务部站点招募了患有糖尿病前期的肥胖/超重退伍军人。
干预措施
VA-DPP包括22次基于小组的强化生活方式改变课程。
主要观察指标
使用退伍军人事务部电子健康记录和索赔数据评估6个月和12个月时的体重变化、12个月时的糖化血红蛋白（HbA1c）以及15个月时退伍军人事务部医疗费用的变化。使用线性混合效应模型对体重和HbA1c进行组间和组内比较，该模型控制了年龄、性别、种族/族裔、基线观察值和站点。分析于2015年至2016年进行。
结果
共有387名参与者入组（273名参与VA-DPP，114名参与MOVE!）。更多参与VA-DPP的参与者完成了至少一次课程（VA-DPP为73.3%，MOVE!为57.5%，p = 0.002）；四次课程（VA-DPP为57.5%，MOVE!为42.5%，p = 0.007）；以及八次或更多课程（VA-DPP为42.5%，MOVE!为31%，p = 0.035）。VA-DPP参与者从基线开始的体重减轻在6个月（p < 0.001）和12个月（p < 0.001）时均显著，但MOVE!参与者仅在6个月时显著（p = 0.004）。组间比较，6个月时的体重减轻存在显著差异（VA-DPP为-4.1千克，MOVE!为-1.9千克，p < 0.001），但12个月时的体重减轻无显著差异（VA-DPP为-3.4千克，MOVE!为-2.0千克，p = 0.16）。HbA1c变化或门诊、住院及退伍军人事务部总费用方面无显著差异。
结论
与MOVE!相比，VA-DPP参与者的参与率更高，6个月时体重减轻更多，但12个月时体重、HbA1c及医疗费用相似。
参与者
VA-DPP的特点可能有助于提高MOVE!覆盖更大比例服务人群的能力，并促进个体层面的体重维持。
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