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标题：Outcomes of a Latino Community-Based Intervention for the Prevention of Diabetes: The Lawrence Latino Diabetes Prevention Project
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作者：Ira S. Ockene ; Trinidad L. Tellez ; Milagros C. Rosal 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2012
卷号：102
期号：2
页码：336-342
DOI：10.2105/AJPH.2011.300357
语种：English
出版社：American Public Health Association
摘要：Objectives. We tested the effectiveness of a community-based, literacy-sensitive, and culturally tailored lifestyle intervention on weight loss and diabetes risk reduction among low-income, Spanish-speaking Latinos at increased diabetes risk. Methods. Three hundred twelve participants from Lawrence, Massachusetts, were randomly assigned to lifestyle intervention care (IC) or usual care (UC) between 2004 and 2007. The intervention was implemented by trained Spanish-speaking individuals from the community. Each participant was followed for 1 year. Results. The participants’ mean age was 52 years; 59% had less than a high school education. The 1-year retention rate was 94%. Compared with the UC group, the IC group had a modest but significant weight reduction (−2.5 vs 0.63 lb; P = .04) and a clinically meaningful reduction in hemoglobin A1c (−0.10% vs −0.04%; P = .009). Likewise, insulin resistance improved significantly in the IC compared with the UC group. The IC group also had greater reductions in percentage of calories from total and saturated fat. Conclusions. We developed an inexpensive, culturally sensitive diabetes prevention program that resulted in weight loss, improved HbA1c, and improved insulin resistance in a high-risk Latino population. Type 2 diabetes is a serious disorder with many complications and is characterized by insulin resistance and relative insulin deficiency. The prevalence of diabetes in Latino Americans is 1.5 times that in non-Latino Whites. 1 Between 1988 to 1994 and 2005 to 2006, the prevalence of diabetes increased from 9.6% to 12.6% in the adult Latino population. 2,3 Prediabetes, as defined by impaired glucose tolerance or impaired fasting blood glucose, is often present 5 or more years before the development of type 2 diabetes. 4 Several randomized clinical trials have shown that it is possible to prevent or delay the progression of the prediabetic state to clinical type 2 diabetes. 5–7 The Diabetes Prevention Program (DPP) demonstrated that a lifestyle intervention incorporating dietary modification and increased physical activity produced an average weight loss of 5.6 kilograms at 1 year and by 4 years reduced the incidence of diabetes by 58% versus usual care. 7 However, the intervention was intensive and costly, beginning with a 16-session curriculum that was delivered individually over 24 weeks and continuing with a number of follow-up individual and group sessions. The total intervention cost over the first year was $1399 per participant. The participants, although representing diverse American subpopulations, were generally well-educated, literate in English, and of average socioeconomic status. The effectiveness of the DPP lifestyle intervention delivered in a lower cost, lower intensity format to high-risk populations is not known. We hypothesized that a community-based, culturally tailored, literacy-sensitive lifestyle intervention delivered in a primarily group-based format would facilitate weight loss and reduce the risk of type 2 diabetes among low-income Latinos at elevated risk of developing diabetes.