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Culturally-adapted Diabetes Prevention Lifestyle Intervention for Latinos (E-LITE Latinos)

Primary Purpose

Prediabetic State, Metabolic Syndrome X, Insulin Resistance

Status
Completed
Phase
Not Applicable
Locations
Study Type
Interventional
Intervention
Vida Sana
Usual Care Only
Sponsored by
Palo Alto Medical Foundation
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional health services research trial for Prediabetic State focused on measuring prediabetes, metabolic syndrome, lifestyle, behavior change, primary care, latinos, diet, physical activity

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion criteria:

  • Age(as of date of enrollment):

    • Lower age limit: 18 years
    • Upper age limit: NONE (only exclude for cause, e.g. disease and functional limitations, as detailed below)
  • Race/ethnicity: Mexican Latino of any race
  • Gender: men and women
  • Body mass index: ≥24 kg/m2 (≥22 kg/m2 if of Asian descent)
  • Having pre-diabetes, metabolic syndrome, or both based on the following criteria:
  • Pre-diabetes according to any one of the following criteria:
  • Fasting plasma glucose of 100 to 125 mg/dL or HbA1c of 5.7 to 6.4 if detected by a recent (within the past year), documented, blood-based diagnostic test or by a fasting blood test during study screening
  • Plasma glucose measured 2 hours after a 75 gm glucose load of 140 to 199 mg/dl if detected by a recent (within the past year), documented, blood-based diagnostic test (Oral glucose tolerance test will not be performed for study screening considering participant burden)
  • Clinically diagnosed gestational diabetes mellitus during a previous pregnancy (may be self-reported)
  • Metabolic syndrome according to 3 or more of the following:

    • Waist circumference ≥40 inches in men and ≥35 inches in women (≥35 inches in men and ≥31 inches in women, if of Asian descent)
    • Triglycerides >150 mg/dL
    • High-density lipoprotein cholesterol (HDL-C) <40 mg/dL in men and <50 mg/dL in women
    • Systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥85 mmHg
    • Fasting plasma glucose of 100 to 125 mg/dL
  • Primary Care Physician approval of patient contact for study screening
  • Able and willing to enroll and provide informed consent, i.e., to meet the time and data collection requirements of the study, be randomized to one of two study arms, participate in follow-up for 24 months, and authorize extraction of relevant information from the Electronic Health Record.

Exclusion criteria:

  • Medical exclusions:
  • Previous diagnosis of diabetes (other than during pregnancy) or diabetes diagnosed as a result of fasting blood glucose or hemoglobin A1c levels obtained through study screening;
  • Diagnosis of cancer (other than non-melanoma skin cancer) that is/was active or treated with radiation or chemotherapy within the past 2 years;
  • Serious medical condition anticipated to prevent person from walking 1 mile (e.g., severe pulmonary disease or aortic stenosis)
  • Severe medical co-morbidities that require aggressive treatment: e.g., stage 4 or greater renal disease, class III or greater heart failure, unstable coronary artery disease, liver or renal failure;
  • Diagnosis of a terminal illness and/or in hospice care;
  • Diagnosis of bipolar disorder or psychotic disorder within the last 2 years, or currently taking a mood stabilizer or antipsychotic medication
  • Initiation or change in type or dosing of antidepressant medications within 2 months prior to enrollment (The patient will be re-contacted for a later cohort once his/her regimen has been stable for at least 2 months unless the person declines to participate altogether.)
  • Have had or plan to undergo bariatric surgery during the study period
  • Other exclusions:
  • Inability to speak, read or understand Spanish or English
  • Having no reliable telephone service
  • Having no regular Internet access via a computer and/or mobile device (e.g., smart-phone)
  • Currently pregnant or lactating or planning to become pregnant during the study period
  • Plan to move out of the area during the study period
  • Family/household member of another study participant or of a study staff member
  • Investigator discretion for clinical safety or protocol adherence reasons

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Active Comparator

    Experimental

    Arm Label

    Usual Care Only

    Vida Sana

    Arm Description

    Patients assigned to this group will continue medical care as usual.

    Patients assigned to this group will continue medical care as usual and in addition will receive the culturally adapted intervention.

    Outcomes

    Primary Outcome Measures

    Change in weight from baseline
    Change in weight

    Secondary Outcome Measures

    Change in composite measure of cardiometabolic risk factors
    Blood pressure, waist circumference, waist-to-height ratio
    Change in Body Mass Index from Baseline
    BMI
    Clinically significant weight loss
    5% or greater weight loss

    Full Information

    First Posted
    May 29, 2015
    Last Updated
    March 6, 2020
    Sponsor
    Palo Alto Medical Foundation
    Collaborators
    Agency for Healthcare Research and Quality (AHRQ), University of Illinois at Chicago, University of Pittsburgh, RTI International, University of California, Santa Cruz
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    1. Study Identification

    Unique Protocol Identification Number
    NCT02459691
    Brief Title
    Culturally-adapted Diabetes Prevention Lifestyle Intervention for Latinos (E-LITE Latinos)
    Official Title
    Culturally-adapted Diabetes Prevention Lifestyle Intervention for Latinos in Primary Care (E-LITE Latinos)
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    March 2020
    Overall Recruitment Status
    Completed
    Study Start Date
    September 2014 (Actual)
    Primary Completion Date
    May 2019 (Actual)
    Study Completion Date
    May 2019 (Actual)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Principal Investigator
    Name of the Sponsor
    Palo Alto Medical Foundation
    Collaborators
    Agency for Healthcare Research and Quality (AHRQ), University of Illinois at Chicago, University of Pittsburgh, RTI International, University of California, Santa Cruz

    4. Oversight

    Data Monitoring Committee
    Yes

    5. Study Description

    Brief Summary
    The purpose of the study is to develop a culturally adapted intervention (CAI) program to improve weight and physical activity in overweight or obese adult Latinos at high risk for developing type 2 diabetes and/or cardiovascular disease (CVD) and to rigorously evaluate the effectiveness and implementation potential of the CAI program.
    Detailed Description
    This study has two phases: Phase 1: Formative research and Phase 2: Randomized Controlled Trial (RCT). The purpose of the formative research phase is to develop a culturally adapted intervention (CAI) program to improve weight and physical activity in overweight or obese adult Latinos at high risk for developing type 2 diabetes and/or cardiovascular disease (CVD). The purpose of the RCT is to rigorously evaluate the effectiveness and implementation potential of the CAI program. The proposed intervention will uniquely adapt the coach-led, technology-supported Group Lifestyle Balance (GLB) program that the investigators proved effective in the investigators' prior trial called E-LITE, to provide culturally and linguistically appropriate lifestyle intervention for weight loss and increased physical activity among high-risk Latinos in primary care. The CAI will be delivered in small groups as well as using existing, rapidly expanding internet and mobile technologies (Website, email, and mobile text messaging). Once developed the investigators will subject the CAI to rigorous evaluation in an RCT of 186 eligible and consenting Latinos. The investigators hypothesize that CAI participants will achieve a greater mean reduction in body mass index (BMI) from baseline to 24 months (primary outcome) than usual care controls. Secondary outcomes will include measures of cardiometabolic risk factors (e.g., lower fasting glucose and lipid levels), psychosocial well-being (e.g., improved mood), and behavior change (e.g., increased physical activity). The overarching research goal is to determine the effectiveness and implementation potential of the CAI based on the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Prediabetic State, Metabolic Syndrome X, Insulin Resistance
    Keywords
    prediabetes, metabolic syndrome, lifestyle, behavior change, primary care, latinos, diet, physical activity

    7. Study Design

    Primary Purpose
    Health Services Research
    Study Phase
    Not Applicable
    Interventional Study Model
    Parallel Assignment
    Masking
    Outcomes Assessor
    Allocation
    Randomized
    Enrollment
    191 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    Usual Care Only
    Arm Type
    Active Comparator
    Arm Description
    Patients assigned to this group will continue medical care as usual.
    Arm Title
    Vida Sana
    Arm Type
    Experimental
    Arm Description
    Patients assigned to this group will continue medical care as usual and in addition will receive the culturally adapted intervention.
    Intervention Type
    Behavioral
    Intervention Name(s)
    Vida Sana
    Intervention Description
    Vida Sana is a Diabetes Prevention Program-based, culturally-adapted intervention that will have 2 distinct stages: The intensive treatment stage will implement a culturally adapted year-long Group Lifestyle Balance curriculum. The curriculum uses a goal-based approach to promote positive outcome expectancies and foster self-efficacy. The maintenance stage will be focused on (1) facilitating continued behavior change; (2) fostering participants' self-efficacy and independence; and (3) reinforcing problem-solving and behavior maintenance skills. These will be done via secure e-messaging.
    Intervention Type
    Other
    Intervention Name(s)
    Usual Care Only
    Intervention Description
    Patients assigned to this group will continue medical care as usual. That is, they will continue to see their primary care provider and any specialist he/she may recommend. They may also access additional health education resources available at the Palo Alto Medical Foundation. They will continue to receive general age and gender-appropriate reminders of health maintenance tests/exams and immunizations, per Palo Alto Medical Foundation standard practice.
    Primary Outcome Measure Information:
    Title
    Change in weight from baseline
    Description
    Change in weight
    Time Frame
    12- and 24-months
    Secondary Outcome Measure Information:
    Title
    Change in composite measure of cardiometabolic risk factors
    Description
    Blood pressure, waist circumference, waist-to-height ratio
    Time Frame
    Baseline, 12- and 24-months
    Title
    Change in Body Mass Index from Baseline
    Description
    BMI
    Time Frame
    12- and 24-months
    Title
    Clinically significant weight loss
    Description
    5% or greater weight loss
    Time Frame
    12 and 24 months

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion criteria: Age(as of date of enrollment): Lower age limit: 18 years Upper age limit: NONE (only exclude for cause, e.g. disease and functional limitations, as detailed below) Race/ethnicity: Mexican Latino of any race Gender: men and women Body mass index: ≥24 kg/m2 (≥22 kg/m2 if of Asian descent) Having pre-diabetes, metabolic syndrome, or both based on the following criteria: Pre-diabetes according to any one of the following criteria: Fasting plasma glucose of 100 to 125 mg/dL or HbA1c of 5.7 to 6.4 if detected by a recent (within the past year), documented, blood-based diagnostic test or by a fasting blood test during study screening Plasma glucose measured 2 hours after a 75 gm glucose load of 140 to 199 mg/dl if detected by a recent (within the past year), documented, blood-based diagnostic test (Oral glucose tolerance test will not be performed for study screening considering participant burden) Clinically diagnosed gestational diabetes mellitus during a previous pregnancy (may be self-reported) Metabolic syndrome according to 3 or more of the following: Waist circumference ≥40 inches in men and ≥35 inches in women (≥35 inches in men and ≥31 inches in women, if of Asian descent) Triglycerides >150 mg/dL High-density lipoprotein cholesterol (HDL-C) <40 mg/dL in men and <50 mg/dL in women Systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥85 mmHg Fasting plasma glucose of 100 to 125 mg/dL Primary Care Physician approval of patient contact for study screening Able and willing to enroll and provide informed consent, i.e., to meet the time and data collection requirements of the study, be randomized to one of two study arms, participate in follow-up for 24 months, and authorize extraction of relevant information from the Electronic Health Record. Exclusion criteria: Medical exclusions: Previous diagnosis of diabetes (other than during pregnancy) or diabetes diagnosed as a result of fasting blood glucose or hemoglobin A1c levels obtained through study screening; Diagnosis of cancer (other than non-melanoma skin cancer) that is/was active or treated with radiation or chemotherapy within the past 2 years; Serious medical condition anticipated to prevent person from walking 1 mile (e.g., severe pulmonary disease or aortic stenosis) Severe medical co-morbidities that require aggressive treatment: e.g., stage 4 or greater renal disease, class III or greater heart failure, unstable coronary artery disease, liver or renal failure; Diagnosis of a terminal illness and/or in hospice care; Diagnosis of bipolar disorder or psychotic disorder within the last 2 years, or currently taking a mood stabilizer or antipsychotic medication Initiation or change in type or dosing of antidepressant medications within 2 months prior to enrollment (The patient will be re-contacted for a later cohort once his/her regimen has been stable for at least 2 months unless the person declines to participate altogether.) Have had or plan to undergo bariatric surgery during the study period Other exclusions: Inability to speak, read or understand Spanish or English Having no reliable telephone service Having no regular Internet access via a computer and/or mobile device (e.g., smart-phone) Currently pregnant or lactating or planning to become pregnant during the study period Plan to move out of the area during the study period Family/household member of another study participant or of a study staff member Investigator discretion for clinical safety or protocol adherence reasons
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Jun Ma, MD, PhD
    Organizational Affiliation
    UIC
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Citations:
    PubMed Identifier
    33337491
    Citation
    Rosas LG, Lv N, Xiao L, Lewis MA, Venditti EMJ, Zavella P, Azar K, Ma J. Effect of a Culturally Adapted Behavioral Intervention for Latino Adults on Weight Loss Over 2 Years: A Randomized Clinical Trial. JAMA Netw Open. 2020 Dec 1;3(12):e2027744. doi: 10.1001/jamanetworkopen.2020.27744.
    Results Reference
    derived
    PubMed Identifier
    26995280
    Citation
    Rosas LG, Lv N, Xiao L, Lewis MA, Zavella P, Kramer MK, Luna V, Ma J. Evaluation of a culturally-adapted lifestyle intervention to treat elevated cardiometabolic risk of Latino adults in primary care (Vida Sana): A randomized controlled trial. Contemp Clin Trials. 2016 May;48:30-40. doi: 10.1016/j.cct.2016.03.003. Epub 2016 Mar 16.
    Results Reference
    derived

    Learn more about this trial

    Culturally-adapted Diabetes Prevention Lifestyle Intervention for Latinos (E-LITE Latinos)

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