Best practices for prevention and management of diabetes are known but not fully implemented in clinical and community settings. Working with the University of Miami, the Health Foundation of South Florida, a community partner in this proposal, created the Healthy Aging Regional Collaborative (HARC) in response to the challenges of chronic disease prevention and management in the elderly. HARC provides health organizations (several lead agencies representing 78 partners) with the tools they need to guard against key health threats: lack of physical activity and inability to manage chronic diseases. With support from federal agencies, HARC seeks (2008-2013) to improve healthy behaviors, reduce healthcare costs, and improve quality of life in approximately 35,000 South Florida older adults. Our study goal is to increase adoption of existing comparative effectiveness research (CER) evidence for prevention and management of diabetes in South Florida overweight/obese (OW JOB) older adults. We will implement findings from the Diabetes Prevention Program (DPP), which demonstrated a 4 year delay over a decade in the onset of diabetes among individuals with prediabetes that received lifestyle intervention, as well as guidelines from the American Diabetes Association for management of diabetes in older adults, which include data from the Veterans Affairs Diabetes Trial (VADT). Both DPP and VADT meet the CER Federal Coordinating Council definition and will be adopted in the HARC network of public and private health care institutions in Miami-Dade, Broward, and Monroe Counties. Specifically, the proposed study will test the hypothesis that Peer-led Care alone (PC), or activated by technology (TechnAlert-Peer or TAP), is superior to traditional methods of information dissemination (Usual Care or UC) for adoption of CER on prevention and management of diabetes, leading to better self-efficacy and clinical outcomes. We propose to conduct a 12-month randomized controlled trial in South Florida older adults with prediabetes or diabetes participating in the HARC with the following primary objectives: 1) Compare changes in self-efficacy between participants receiving peer-led care (with or without TAP intervention) and those receiving UC. 2) Compare changes in weight and hemoglobin A1C between participants receiving peer-led care (with or without TAP intervention) and those receiving UC. In addition, we proposed the following secondary objectives on process and health outcomes: a) Perform a needs assessment to elucidate ways older adults participating in the HARC seek information related to prevention and management of diabetes. b) Assess the availability of peer-leaders and the role of technology to increase adoption of CER for prevention and management of diabetes. c) Evaluate potential racial ethnic disparities in the process of adoption of CER for prevention and management of diabetes. d) Compare changes in blood pressure, lipids, physical function, and quality of life among treatment groups (UC, PC, and TAP). e) Compare changes in health care utilization (physician visits, emergency visits, and days in hospital) among treatment groups (UC, PC, and TAP).
This proposal to accelerate adoption of comparative effectiveness research (CER) evidence for diabetes prevention and management in South Florida older adults will provide practical knowledge and resources on novel strategies for applicability in large, multi-ethnic communities. This collaborative effort will enable further translation of CER to reduce the medical and financial burden of chronic diseases in the elderly, one of the fastest growing segments of the US population.
