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

项目总结 美国被诊断为2型糖尿病的人数增加了一倍多 自2000年以来增加到3000多万人，另有8410万人患有糖尿病前期。一个少数族裔群体在 特别危险的是太平洋岛民(PI)，他们面临着不成比例的风险，并面临许多障碍(结构性和 文化)到从事预防或自我护理。为了满足糖尿病预防和治疗的迫切需要 针对PI的治疗计划，并建立在以家庭为中心的文化基础上，我们的目标是试点测试和 评估一项旨在改善青少年干预的随机对照试验 诊断为糖尿病的成对成年家庭成员的血糖控制和自我护理实践。在基础上建设 我们自己之前的工作我们已经调整了一个有效的、基于初级保健的糖尿病自我管理计划 为青少年提供服务。具体地说，我们细化了干预内容，将重点放在有助于 为了在程序的前几次迭代中控制血糖，调整了内容以针对青少年作为代理 通过增加沟通和领导技能来改变，并纳入体验式学习活动。我们 将通过一项试点随机对照试验来检查干预的效果。我们将随机化n=160 双亲(青少年(无糖尿病)和诊断为糖尿病的父母/祖父母，有共同的 家庭)。青少年将接受为期六个月的糖尿病干预，或者接受领导力和生活技能- 集中控制课程分组(n=10人/组)。除了计划中的研究 评估我们将不会与二元体中的成年人接触，他们将继续他们通常的糖尿病 关心。来验证我们的假设，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照顾策略，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，因为我们认为，接触干预措施可能会鼓励积极的 青少年自身的行为变化我们将在青少年中测量类似的结果。 将在积极干预阶段结束时(六个月后)在基线上衡量结果 随机化)和随机化后12个月，以检查干预效果的维持情况 没有联系。为了确定长期可持续性的潜力并扩大规模，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有效性证明将 产生创新的、可扩展的计划，具有在其他类似、低资源、 全美以家庭为中心的少数民族群体是减少贫困的创新的理想受益者 降低慢性病风险，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.