标题：The Live Well, Be Well Study: A Community-Based,
Translational Lifestyle Program to Lower Diabetes Risk Factors in Ethnic
Minority and Lower–Socioeconomic Status Adults
摘要：Objectives. We evaluated a community-based, translational lifestyle program to reduce diabetes risk in lower–socioeconomic status (SES) and ethnic minority adults. Methods. Through an academic–public health department partnership, community-dwelling adults at risk for diabetes were randomly assigned to individualized lifestyle counseling delivered primarily via telephone by health department counselors or a wait-list control group. Primary outcomes (6 and 12 months) were fasting glucose level, triglycerides, high- and low-density lipoprotein cholesterol, weight, waist circumference, and systolic blood pressure. Secondary outcomes included diet, physical activity, and health-related quality of life. Results. Of the 230 participants, study retention was 92%. The 6-month group differences for weight and triglycerides were significant. The intervention group lost 2 pounds more than did the control group ( P = .03) and had decreased triglyceride levels (difference in change, 23 mg/dL; P = .02). At 6 months, the intervention group consumed 7.7 fewer grams per day of fat ( P = .05) and more fruits and vegetables ( P = .02) than did control participants. Conclusions. Despite challenges designing effective translational interventions for lower-SES and minority communities, this program modestly improved some diabetes risk factors. Thus, individualized, telephone-based models may be a promising alternative to group-based interventions. The prevalence of type 2 diabetes continues to rise at an alarming rate in the United States. Approximately 25.6 million adults (11.3% of the US population aged 20 years or older) have diabetes, and another estimated 79 million have prediabetes. 1 Greater risk of diabetes is observed for ethnic minority 1–5 and lower–socioeconomic status (SES) groups 6 compared with White adults of similar ages. Several clinical trials have tested intensive lifestyle interventions or pharmacological agents in preventing or delaying type 2 diabetes in adults at risk. 7–9 These trials showed impressive diabetes risk reductions for lifestyle interventions associated with relatively modest amounts of weight loss and exercise. 7–9 Translating this knowledge into lifestyle interventions delivered in real-world settings is thus a major priority. 10–12 To reduce observed disparities in risk of diabetes, translational studies need to be community-based and designed for lower-SES and ethnic minority populations. Although many translational lifestyle interventions are available, most were designed for clinical settings; 13–21 only a few are offered in community settings. 22–26 Of community-based translations, only 3 were designed specifically for lower-SES or minority populations, 23–25 and only 1 of these—Project HEED, or Help Educate to Eliminate Diabetes—was evaluated with a randomized controlled trial design. 23 HEED was successful in obtaining significant group differences in weight loss at 12 months, but no other significant clinical or behavioral changes were observed. We conducted a randomized controlled trial of a low-intensity lifestyle intervention for lower-SES, ethnic minority, Spanish- and English-speaking adults. This was a collaborative project between the University of California, San Francisco, and the City of Berkeley Division of Public Health. Public health departments are a good venue for community-based translations to reduce disparities because they serve vulnerable populations most at risk for chronic disease and engage in chronic disease prevention.
