Preventing Type 2 Diabetes in At-Risk Youth

描述(申请人提供)：随着年轻人中2型糖尿病(T2 DM)患病率的增加，以及这些年轻人在幼年就有可能经历糖尿病的破坏性并发症，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T2 DM高危城市青年的体重指数(BMI)、胰岛素抵抗、肥胖、血脂、健康行为、抑郁和自我效能的影响。试验组在12个月后的反应将与那些接受延迟干预的年轻人进行比较。(2)考察基线特征(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)探索青少年和家庭管理肥胖和胰岛素抵抗预防2型糖尿病的经验。为实现这些目标，我们将招募240名高危六年级中学生。高风险被定义为BMI&>85百分位数。学校将被随机分配到试验性或延迟干预条件下。试验性干预是一项以社区为基础的、多方面的干预计划，我们已经进行了广泛的试点测试，并将在纽黑文非常高风险社区的中学进行。数据将在干预前以及干预后4个月和13个月收集，并使用BMI的主要结果-胰岛素抵抗。修订后的Godin-Shephard活动调查和加速计数据、饮食习惯问卷、健康行为问卷、青少年儿童抑郁量表和父母健康促进生活方式简介。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式方法和扎根理论方法。预计这项重要和及时的研究将提供有价值的信息，帮助年轻人管理肥胖，并潜在地预防T2 DM及其长期的生理和心理社会并发症。

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.