Modified Project Summary/Abstract Section Candidate: Dina H. Griauzde, MD, MSc is a general internist and early career health services researcher focused on preventing type 2 diabetes (T2DM). Dr. Griauzde’s long-term career objective is to become an independent physician-scientist leading the development and evaluation of tailored, multilevel interventions for T2DM prevention that can be scaled and sustained within diverse practice settings. Research Context: Weight loss is the key driver of T2DM risk reduction. Patients prefer and benefit from preference-sensitive weight loss treatment plans, which may require adaptations over time to optimize outcomes. While primary care providers and practices theoretically play a central role in supporting patients’ weight loss, they lack coordinated, effective, and sustainable strategies to personalize and adapt treatment plans to help more individuals with prediabetes achieve clinically significant weight loss. Accordingly, obesity remains poorly managed in primary care settings. Specific Aims: The overarching aim of this proposal is to use implementation science (i.e., the study of provider behavior within the context of organizational constraints) to develop, implement, and evaluate a novel multilevel intervention to support personalized and adaptable weight loss treatment plans in primary care settings. Multilevel interventions target at least two levels of influence (e.g., providers, health system) and are a promising strategy to promote significant and sustained changes in clinical practice. Intervention components will be selected to address key determinants of successfully supporting patients’ weight loss. Research Plan: Dr. Griauzde will use a theory-based implementation science checklist to guide semi-structured interviews with patients, providers, practice staff, and system leaders to identify determinants of successfully supporting patients’ weight loss (Aim 1). She will then link key determinants to evidence- and theory-based implementation strategies to develop of a novel, multilevel intervention, consisting of (1) personalized weight loss plans; (2) remote weight monitoring; and (3) proactive outreach by primary care teams and/or automated tools to provide support and/or adapt treatment plans to optimize weight loss (Aim 2). She will evaluate the intervention using a match cohort analysis (Aim 3). These data will inform a future multisite study of the refined intervention. Career Development Plan: Dr. Griauzde will develop expertise in (1) implementation science; (2) multilevel intervention design; and (3) mixed methods design and evaluation of clinical programs. Dr. Griauzde’s training will be supported by experienced, interdisciplinary mentors; advanced didactic coursework; and participation in research and career development meetings and seminars within an ideal training environment. This award will enable Dr. Griauzde to become an independent investigator and national leader in developing, testing, and implementing multilevel interventions for the prevention of T2DM and other obesity-related chronic conditions.

Modified Public Health Relevance Section Modest weight loss (>5% body weight) is the most effective strategy to help individuals with prediabetes prevent or delay type 2 diabetes mellitus. Most individuals with prediabetes, however, do not engage in evidence-based Diabetes Prevention Programs for weight loss, and healthcare systems currently lack effective, coordinated, and patient-centered strategies to successfully support patients’ weight loss with other evidence-based resources (e.g. behavioral change programs, pharmacotherapy). This proposal aims to develop and test an innovative, multilevel primary care-based intervention to support weight loss among adults with prediabetes through (1) personalized weight loss plans; (2) remote weight monitoring using home-based digital scales; and (3) proactive outreach to address barriers and/or adapt plans if target weight loss is not achieved.