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
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
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
NCT ID
NCT02459691
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
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
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Culturally-adapted Diabetes Prevention Lifestyle Intervention for Latinos (E-LITE Latinos)
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