Abstract P054: Translation of Diabetes Interventions Into Community Settings: 12-month Results of the Lifestyle Intervention for the Treatment of Diabetes Trial
Notice bibliographique
Résumé
Objective: Professionally delivered intensive lifestyle weight loss interventions (LWLs) have been shown to improve weight status and CVD risk factors among adults with diabetes in rigorously conducted trials. We report the 12-month results of a trial in which a LWL was delivered by community health workers (CHWs), among predominantly minority and/or lower socioeconomic status participants. Research Design and Methods: We recruited overweight or obese adults with diabetes and without CVD primarily via review of electronic medical records and physician referrals. The study featured two 12-month interventions: (1) LWL delivered by trained CHWs in community settings which involved weekly group sessions and 3 individual sessions with an interventionist, or (2) diabetes self-management education (DSM) comprised of 12 monthly group sessions delivered at a primary care clinic. The main outcome was change in United Kingdom Prospective Diabetes Study (UKPDS) estimated 5-year CVD risk at 12 months; secondary outcomes included weight loss, UKPDS risk score components (hemoglobin A1c, blood pressure, lipids) and use of medications affecting these components. Results: We screened 1102 and randomized 260 adults (age range 23-83, mean 55.9, 67% female, 48% black, 52% < college degree, mean A1c 7.6%, 37.3% A1c<7%, mean BMI 37.7 kg/m 2 ). Baseline demographic and CVD risk factors were equally distributed between the 2 groups of 130 participants each. At 12 months, 92.3% of LWL and 98% of DSM participants were retained. There was not a significant difference in 5-year UKPDS estimated CVD risk by arm (increased from 5.1% to 5.9% in LWL, and 5.5% to 6.1% in DSM, group comparison p=0.61). There was no evidence of effect modification by the pre-specified parameters of gender, race/ethnicity or baseline BMI. Follow-up A1c, SBP, and total cholesterol did not significantly differ by arm. Weight loss was greater in LWL compared to DSM participants (mean of 3.2% vs 1.1% of total body weight, p=0.02). At least 5% weight loss was achieved by 30.8% of LWL and 18.1% of DSM participants (p=0.02). Among LWL participants, 11.7% discontinued their diabetes medication compared to only 1.6% of DSM participants (p=0.005); 87.5% of those who discontinued medication had achieved an A1c<7% at follow-up, compared to 36.8% who continued using diabetes medication. Hypertension and lipid lowering medication use did not differ by arm. Conclusions: In a diverse sample of adults with diabetes, a CHW-delivered LWL intervention produced greater weight loss compared to a monthly DSM education, but did not appreciably alter 5-year UKPDS-estimated CVD risk, A1c, or CVD risk factors. The average weight loss achieved (3.2%) may not have been sufficient to produce meaningful changes in metabolic functioning and CVD risk factors, however, some participants in both interventions achieved improved glycemic control without use of medications.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».