An Adolescent-mediated intervention to improve diabetes prevention and management in Pacific Islander Families

项目摘要 在美国，被诊断患有2型糖尿病的人数增加了一倍多。 自2000年以来，糖尿病患者增加到3000多万人，另有8410万人患有前驱糖尿病。一个少数群体在 太平洋岛民面临的风险尤其大，他们面临的风险不成比例，面临着许多障碍（结构性障碍和 文化），以从事预防或自我保健。为了满足预防糖尿病的迫切需要， 治疗方案，目标是PI，并建立在以家庭为中心的文化，我们的目标是试点测试， 评估一项青少年介导干预的随机对照试验，旨在改善青少年的健康状况 一对被诊断患有糖尿病的成年家庭成员的血糖控制和自我护理实践。基础上 我们自己先前的工作，我们已经适应了一个有效的，以初级保健为基础的糖尿病自我管理计划， 用于青少年。具体来说，我们改进了干预内容，重点关注那些 在该计划的先前迭代中，将内容调整为目标青少年，作为 通过增加沟通和领导技能进行变革，并纳入体验式学习活动。我们 将通过随机对照试验来检验干预的有效性。我们将随机化n=160 二人组（青少年（无糖尿病）和父母/祖父母诊断患有糖尿病， 家庭）。青少年将接受为期六个月的糖尿病干预或领导和生活技能- 分组集中控制课程（每组10名参与者）。除了计划中的研究 评估我们将不会与二分体中的成年人接触，他们将继续他们通常的糖尿病 在乎为了验证我们的假设，即接受干预的青少年将是糖尿病的有效渠道， 知识，并将支持他们配对的成年人采取自我护理策略，我们的主要功效 结果将是成人血糖控制和心血管危险因素（BMI，血压，腰围， 周长）。其次，由于我们认为接触干预可能会鼓励积极的 我们将在青少年中测量类似的结果。 将在基线、积极干预阶段结束时（干预后6个月）测量结果。 随机化）和随机化后12个月，以检查 没有接触。为了确定长期可持续性和扩大规模的潜力，我们将审查计划 可接受性、可行性、保真度、覆盖范围和成本。成功完成我们的目标和证明有效性将 产生一个创新的，可扩展的计划，具有很高的潜力，复制在其他类似的，低资源， 美国各地以家庭为中心的少数民族群体，他们是创新的理想受益者， 慢性病风险和消除健康差距。

PROJECT SUMMARY The number of individuals diagnosed with Type 2 Diabetes in the United States (US) has more than doubled since 2000 to over 30 million, with an additional 84.1 million living with prediabetes. One minority group at particular risk is Pacific Islanders (PIs), who are at disproportionate risk and face many barriers (structural and cultural) to engaging in prevention or self-care. To address the critical need for diabetes prevention and treatment programs that target PIs, and building on the family-centered culture, our objective is to pilot test and evaluate a randomized controlled trial of an adolescent-mediated intervention designed to improve the glycemic control and self-care practices of a paired, adult family member with diagnosed diabetes. Building on our own prior work we have adapted an efficacious, primary care-based diabetes self-management program for delivery to adolescents. Specifically, we refined intervention content to focus on behaviors that contributed to glycemic control in prior iterations of the program, adapted the content to target adolsecents as agents of change by adding communication and leadership skills, and incorporated experiential learning activities. We will examine the efficacy of the intervention with a pilot randomized controlled trial. We will randomize n=160 dyads (an adolescent (without diabetes) and a parent/grandparent diagnosed with diabetes who share a household). Adolescents will receive either the six-month diabetes intervention or a leadership and life skills- focused control curriculum in groups (n=10 participants in each group). Aside from planned research assessments we will have no contact with the adults in the dyad, who will proceed with their usual diabetes care. To test our hypothesis that adolescents receiving the intervention will be effective conduits of diabetes knowledge and will support their paired adult in the adoption of self-care strategies, our primary efficacy outcomes will be adult glycemic control and cardiovascular risk factors (BMI, blood pressure, waist circumference). Secondarily, since we believe that exposure to the intervention may encourage positive behavior change in the adolescent themselves we will measure similar outcomes in the adolescents. Outcomes will be measured at baseline, at the end of the active intervention phase (six months post- randomization) and at 12-months post-randomization, to examine maintenance of intervention effects in the absence of contact. To determine potential for long-term sustainability and scale up, we will examine program acceptability, feasibility, fidelity, reach, and cost. Successful completion of our aims and proof of efficacy would produce an innovative, scalable program with high potential for replication in other similar, low-resource, family-centered, ethnic minority groups across the US who are the ideal beneficiaries of innovations to reduce chronic disease risk and eliminate health disparities.