Preventing Type 2 Diabetes in At-Risk Youth

描述（由申请人提供）：随着2型糖尿病（T2DM）在青少年中的患病率日益增加，以及这些年轻人在早期经历糖尿病毁灭性并发症的可能性，必须开发和测试新的糖尿病预防方法。在这项研究中，我们建议：(1)采用前瞻性随机临床试验设计，我们将确定以学校为基础的多方面干预（营养和运动教育、应对技能培训、高级执业护士（APN）指导和基础设施改变）对市中心T2DM高风险青年体重指数（BMI）、胰岛素抵抗、肥胖、血脂、健康行为、抑郁和自我效能感的影响。实验组在12个月内的反应将与那些接受延迟干预的青少年进行比较。(2)其次，我们将研究基线特征（年龄、性别、基线健康行为、抑郁）和家庭行为对干预反应的影响；(3)最后，探讨青少年和家庭管理肥胖和胰岛素抵抗在2型糖尿病预防中的经验。为了实现这些目标，我们将招收240名高危六年级中学生。BMI指数为85个百分位数为高风险。学校将被随机分配到试验性或延迟干预条件下。实验干预是一个以社区为基础的，多方面的干预项目我们已经进行了广泛的试点测试并将在纽黑文高危社区的中学进行。数据将在干预前和干预后4个月和13个月收集，主要指标为BMI、胰岛素抵抗。修订的Godin-Shephard活动调查和加速度计数据、饮食习惯问卷、健康行为问卷、青少年儿童抑郁问卷和家长健康促进生活方式问卷。有目的的家庭样本将参加一系列开放式访谈。分析将包括重复测量、方差分析、广义估计方程方法和扎根理论方法。这项重要而及时的研究将为帮助青少年控制肥胖提供有价值的信息，并有可能预防2型糖尿病及其长期的身体和心理并发症。

DESCRIPTION (provided by applicant): With the increasing prevalence of type 2 diabetes (T2DM) 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 investigation we propose to: (1) Using a prospective, randomized clinical trial design, we will determine the effect of school-based, multifaceted intervention (nutrition and exercise education, coping skills training, Advanced Practice Nurse (APN) coaching, and infrastructure change) on Body Mass Index (BMI), insulin resistance, adiposity, lipids, health behaviors, depression, and self-efficacy in inner city youth at high risk for T2DM. Responses in the experimental group over 12 months will be compared to those youth who receive a delayed intervention. (2) Secondarily, we will examine the effects of baseline characteristics (age, gender, baseline health behaviors, depression) and family behaviors on the response to the intervention; and (3) Finally, we will explore the experience of youth and family in management of obesity and insulin resistance in the prevention of type 2. To achieve these aims, we will enroll 240 high-risk 6th grade middle school youth. High risk is defined as BMI >85th percentile. Schools will be randomized to experimental or delayed intervention conditions. The experimental intervention is a community-based, multifaceted intervention program that we have extensively pilot-tested and will be conducted in the middle schools in the very high-risk community of New Haven. Data will be collected pre intervention and at 4 and 13 months following using the primary outcome of BMI, insulin resistance. Revised Godin-Shephard Activity Survey and accelerometer data, Eating Habits Questionnaire, Health Behavior Questionnaire, Children's Depression Inventory for the youths and the Health Promoting Lifestyle Profile for the parents. A purposive sample of families will participate in a series of open-ended interviews. Analyses will include repeated measures ANOVA generalized estimating equation method, and grounded theory approaches. It is expected that this important and timely study will provide valuable information to help youth manage obesity, and potentially prevent T2DM and its long-term physical and psychosocial complications.