The preliminary efficacy of a culturally tailored, telehealth lifestyle intervention for Black adolescent girls with prediabetes: a pilot randomized controlled trial

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PROJECT SUMMARY Type 2 diabetes mellitus (T2DM), an obesity-related chronic disease, disproportionally impacts the lives of Black adolescent girls, which contributes to racial/ethnic disparities in T2DM incidence and mortality rates experienced by Black women. Diet and physical activity are shown to reduce T2DM risk, but Black adolescent girls with T2DM are not meeting recommendations for either. Lifestyle interventions for adolescents primarily target those with prediabetes (not T2DM), are adaptations of the Diabetes Prevention Program, and only modestly reduce T2DM-risk factors. Limitation of existing T2DM-related lifestyle interventions include: 1) barriers to program participation, 2) barriers to making and sustaining behavior changes, 3) do not include a cooking component, 4) are not culturally tailored, and 5) evaluate changes in body mass index but not in glycemic measures (e.g., glycated hemoglobin, oral glucose tolerance test), which is a direct predictor of T2MD. For the proposed study, we will examine the preliminary efficacy of our 12-week culturally tailored, telehealth lifestyle intervention called Black Girls for Wellness (BGW). The study is informed by the Social Cognitive Theory, which posits that personal (e.g., self-efficacy), behavioral (e.g., skills), and environmental (e.g., social and physical) factors influence behaviors (e.g., diet and physical activity) and health outcomes (e.g., body composition and glycemic measures). Each week participants will engage in 3 activities: 1) a live stream group nutrition lesson and check-in (60 min/week), 2) a cooking experience at home preparing a healthy ethnic meal using ingredients sent via Amazon Fresh (60 min/week), and 3) live stream Afrocentric dance classes (60 min 3 days/week). We will recruit Black adolescent girls (12-18 y) with overweight or obesity and prediabetes from the New York Presbyterian-Weill Cornell Medicine Pediatric Endocrinology Clinic (Manhattan, NY) to participate in a pilot randomized controlled trial (RCT) (n=60; 30-intervention, 30-control). After end-point data collection, the control group will participate in the BGW. The proposed study is innovative through the use of telehealth delivery methods, hands on cooking experiences and physical activity that are culturally tailored, and glycemic measures that are proximal to T2DM risk. The American Diabetes Association recommends telehealth and culturally tailored lifestyle interventions to address systems level inequities in healthcare access, yet these methods have yet to be explored with Black adolescent girls with prediabetes. Our central hypothesis is that the intervention group will experience significant improvements in diet quality (primary outcome), physical activity, body composition, and glycemic measures, as compared to the control group. The long-term goal is to establish an evidence-based, culturally tailored, telehealth diabetes prevention intervention that can be scaled to address the needs of Black adolescent girls with prediabetes, a high risk and underserved population.