PREVENTING TYPE 2 DIABETES IN HIGH RISK TEENS

Yale University, New Haven CT

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Abstract

DESCRIPTION (adapted from the application) With the increasing prevalence of type 2 diabetes in youth, and the potential for these youth to experience the devastating complications of diabetes at an early age, new approaches to diabetes prevention must be developed and tested. In this pilot investigation: (1) Using a prospective, randomized clinical trial design, we will determine preliminary effects of a community-based diet, education, and coping skills training (CST) program on self-management (Body Mass Index (BMI), insulin resistence, health behaviors) and psychosocial well-being (depression, self-efficacy). Response in the CST group over 12 months will be compared to those youth who receive routine care with group dietary and educational sessions. (2) Secondarily, we will examine the effects on mediating factors such as patient characteristics (age, gender, baseline health behaviors, depression) and family structure, beliefs and behaviors on the response to CST. (3) Finally, we will explore how youth and families experience the CST intervention and their management of obesity and insulin resistance. To achieve these aims, we will screen 75 middle school children with BMI >85th percentile for insulin resistance to achieve a sample of 50 subjects. Those who are insulin resistant will be randomized to one of two community-based interventions: diet, exercise and CST or diet and exercise without CST. CST focuses on problem solving and emotion management in coping with the management of obesity. Data will be collected pre and post intervention and at 3, 6, and 12 months following using the primary outcome of BMI, insulin resistance, central adiposity, Child Feeding Questionnaire, Revised Godin-Shephard Activity Survey, Health Behavior Questionnaire, Children's Depression Inventory for the youths and the Health Promoting Lifestyle Profile for the family. A purposive sample of families will participate in a series of open-ended interviews. Analyses will include repeated measures ANOVA and grounded theory approaches. It is expected that this important and timely study will provide valuable information to support a full-scale study of these issues, help other youth manage obesity, and potentially prevent type 2 diabetes and its long-term physical and psychosocial complications.