Cognitive-Behavioral Therapy and Exercise Training in Adolescents At-Risk for Type 2 Diabetes

对有 2 型糖尿病风险的青少年进行认知行为治疗和运动训练

• 批准号: 10592344
• 负责人: LAUREN BERGER SHOMAKER
• 金额: $ 66.27万
• 依托单位: COLORADO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10592344
• 关键词: Accounting; Address; Adherence; Adolescence; Adolescent; Adult; Affect; Aftercare; Behavior Therapy; Body mass index; Chronic Disease; Cognitive Therapy; Communities; Control Groups; Data; Depressed mood; Diabetes prevention; Disadvantaged; Disease; Effectiveness; Ethnic Origin; Ethnic Population; Exercise; Fasting; Female; Female Adolescents; Frequencies; Goals; Health; Health education; Healthcare; Hour; Individual; Insulin; Insulin Resistance; Intervention; Interview; Life Expectancy; Mediating; Mediator; Mental Depression; Mental Health; Metabolic; Methods; Mission; National Institute of Diabetes and Digestive and Kidney Diseases; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Outcome; Pathway interactions; Persons; Phenotype; Physical Fitness; Physical activity; Physiological; Prevention; Prevention strategy; Public Health; Quality of life; Race; Randomized; Randomized, Controlled Trials; Research; Risk; Stress; Teenagers; Time; United States National Institutes of Health; Work; Youth; arm; attentional control; cardiorespiratory fitness; center for epidemiological studies depression scale; child depression; combat; comorbidity; comparative efficacy; cost; cost effective; cost effective intervention; depressive symptoms; diabetes risk; effective therapy; efficacious intervention; efficacy study; exercise training; experience; fitness; follow-up; improved; insulin sensitivity; physical inactivity; post intervention; process evaluation; programs; racial population; sedentary; socioeconomics; standard of care

Project Summary/Abstract There has been rapid escalation in adolescent-onset type 2 diabetes (T2D), particularly in females from historically disadvantaged racial/ethnic groups. Prevention is critical because adolescent-onset T2D often shows a more aggressive disease course than adult-onset, and effective treatment options remain elusive. Standard- of-care for T2D prevention includes exercise training to ameliorate insulin resistance, a key physiological precursor to T2D. Despite short-term benefits, exercise training shows insufficient effectiveness in adolescents at-risk for T2D. Depression may be explanatory in a considerable subset of teenagers. Adolescence is notable for increases in depression and decreases in physical activity, especially in females with obesity. Youths' depression symptoms contribute to worsening insulin resistance over time, independent of BMI (kg/m2), likely through stress-mediated pathways such as reduced physical activity and fitness. Also, adolescent depression is associated with decreased physical activity and cardiorespiratory fitness, even after accounting for adiposity, and depression predicts greater non-adherence to exercise training. The central theme of this proposal is that an intervention sequence of delivering cognitive-behavioral therapy (CBT) first, followed by intervening with exercise training second, will offer a targeted, efficacious strategy for improving insulin resistance and consequently, lowering T2D risk in adolescent females at-risk for T2D with depression symptoms. In a prior NIH/NIDDK K99/R00 randomized controlled trial (RCT), we found that 6-week group CBT decreased depression at 6-week follow-up in adolescent females at-risk for T2D with moderately elevated depression, compared to a 6-week didactic health education control group. Adolescents with elevated depression who were randomized to CBT had lower fasting and 2-hour insulin at 1-year vs. controls. Our preliminary data suggest that CBT's focus on enhancing frequency/enjoyment of physical activity to combat depressed mood partially explained why decreasing depression lowered T2D risk. It is not known if CBT is just as efficacious as standard-of-care exercise training, or whether CBT followed by exercise training results in a maximally potent alleviation of T2D risk in adolescent females at-risk for T2D with depression symptoms. To address these gaps and directly build on our prior work, we propose a four-arm RCT to: (1) Compare the efficacy of four 6-week6-week sequences for improving insulin resistance in N=300 adolescent females at-risk for T2D with elevated depression symptoms: (i) CBTexercise, (ii) exerciseCBT, (iii) CBT only (CBTcontinue CBT), and (iv) exercise only (exercisecontinue exercise); (2) Evaluate physical activity/fitness as mediators underlying the depression- insulin resistance association; and (3) Evaluate underlying mechanisms by which decreasing depression increases physical activity and improves fitness and insulin resistance using a mixed-methods process evaluation. Findings will support our long-term goal to identify feasible, cost-effective intervention strategies with high potential for effective dissemination to adolescents at-risk for T2D with elevated depression symptoms.

项目总结/摘要 2型糖尿病（T2 D）的发病率迅速上升，特别是在来自 历史上处于不利地位的种族/族裔群体。预防是至关重要的，因为糖尿病发作的T2 D往往表现为 比成人发病更具侵略性的疾病过程，有效的治疗方案仍然难以捉摸。标准- 预防T2 D的护理包括运动训练以改善胰岛素抵抗，这是一个关键的生理学问题。 T2 D的前兆尽管有短期的好处，运动训练在青少年中显示出不足的有效性 有T2 D的风险抑郁症可能是一个相当大的青少年子集的解释。青春期值得注意 抑郁症的增加和体力活动的减少，特别是在肥胖的女性中。青年的 随着时间的推移，抑郁症状可能会导致胰岛素抵抗恶化，与BMI（kg/m2）无关， 通过压力介导的途径，如减少体力活动和健身。此外，青少年抑郁症是 与体力活动和心肺功能下降有关，即使考虑到肥胖， 抑郁症预示着更大的不坚持运动训练。这项建议的中心主题是， 首先进行认知行为治疗（CBT），然后进行干预， 其次，运动训练将提供一个有针对性的，有效的改善胰岛素抵抗的策略， 因此，降低具有抑郁症状的T2 D风险的青少年女性的T2 D风险。在现有 NIH/NIDDK K99/R 00随机对照试验（RCT），我们发现6周组CBT降低抑郁症 在6周的随访中，有中度抑郁症的T2 D风险的青少年女性， 6-健康教育周为对照组。抑郁程度升高的青少年被随机分配到 与对照组相比，CBT在1年时的空腹和2小时胰岛素水平较低。我们的初步数据表明，CBT的重点是 提高身体活动的频率/享受，以对抗抑郁情绪，部分解释了为什么 减少抑郁降低了T2 D风险。目前尚不清楚CBT是否与标准护理运动一样有效 训练，或者CBT后进行运动训练是否能最大限度地缓解T2 D风险， 有抑郁症状的T2 D风险的青少年女性。为了解决这些差距，并直接建立在我们的 在之前的工作中，我们提出了一个四臂随机对照试验：（1）比较四个6周和6周序列的疗效， 改善N=300例有抑郁症状升高的T2 D风险的青少年女性的胰岛素抵抗： (i)CBT重复练习，（ii）练习重复CBT，（iii）仅CBT（CBT重复继续CBT），以及（iv）仅练习 （运动和继续运动）;（2）评估身体活动/健身作为抑郁症的中介- 胰岛素抵抗相关;（3）评估降低抑郁症的潜在机制 增加体力活动，改善健身和胰岛素抵抗使用混合方法的过程 评价研究结果将支持我们的长期目标，以确定可行的，具有成本效益的干预策略， 有效传播给具有抑郁症状升高的T2 D风险青少年的可能性很高。