Preventing Diabetes in Latino Youth

 描述(由申请人提供)：肥胖和相关的健康差距是社会面临的一些最重大的公共卫生挑战。特别是，肥胖的拉丁裔青少年受到胰岛素抵抗和2型糖尿病的影响不成比例。糖尿病前期是2型糖尿病发病机制的中间阶段，是进行干预的关键时机。糖尿病预防计划确定，生活方式干预可以预防或推迟患有糖尿病前期的成年人的2型糖尿病。到目前为止，还没有对患有糖尿病前期的肥胖拉丁裔青年进行糖尿病预防研究，这是一个高度脆弱和服务不足的群体。因此，我们提出了一项随机对照试验，以测试与常规护理相比，基于文化的生活方式干预在120名患有糖尿病前期的肥胖拉美裔青少年中改善糖耐量和降低糖尿病风险的短期(6个月)和长期(12个月)有效性。我们将进一步测试干预对生活质量的影响，探索总脂肪、局部脂肪和器官脂肪变化在改善糖耐量和提高胰岛素敏感性方面的潜在中介作用，并估计与改善糖耐量的常规护理相比，干预最初的增量成本-效果。在青春期的关键过渡期，当健康行为和健康结果的变化与未来的健康轨迹联系在一起时，整体方法被框架在一个多层次的生态发展模型中，该模型利用了社区、家庭、同伴和个人因素。该干预以社会认知理论为指导，采用关键的行为矫正策略来提高自我效能感，培养社会支持，以做出和维持健康的行为改变。该应用程序建立在一个与当地社区机构协同工作的跨学科调查小组现有合作的基础上，以解决针对拉美裔肥胖青年的糖尿病预防干预措施的制定、实施和评估方面的严重差距。这一创新方法是开发可扩展的、具有成本效益的、以解决方案为导向的计划的关键一步，以预防该人群和其他高危青年人群中的2型糖尿病。

 DESCRIPTION (provided by applicant): Obesity and related health disparities represent some of the most significant public health challenges facing society. In particular, obese Latino adolescents are disproportionately impacted by insulin resistance and type 2 diabetes. Prediabetes is an intermediate stage in the pathogenesis of type 2 diabetes and represents a critical opportunity for intervention. The Diabetes Prevention Program established that lifestyle intervention can prevent or delay type 2 diabetes in adults with prediabetes. To date, no diabetes prevention studies have been conducted in obese Latino youth with prediabetes, a highly vulnerable and underserved group. Therefore, we propose a randomized-controlled trial to test the short-term (6-month) and long-term (12-month) efficacy of a culturally-grounded, lifestyle intervention, as compared to usual care, for improving glucose tolerance and reducing diabetes risk in 120 obese Latino adolescents with prediabetes. We will further test intervention effects on quality of life, explore the potential mediating effects of changes in total, regional, nd organ fat on improving glucose tolerance and increasing insulin sensitivity, and estimate the initial incremental cost- effectiveness of the intervention as compared with usual care for improving glucose tolerance. The overall approach is framed within a multilevel Ecodevelopmental model that leverages community, family, peer, and individual factors during the critical transition period of adolescence when changes in health behaviors and health outcomes are linked to future health trajectories. The intervention is guided by Social Cognitive Theory and employs key behavioral modification strategies to enhance self-efficacy and foster social support for making and sustaining healthy behavior changes. The application builds upon extant collaborations of a transdisciplinary team of investigators working in concert with local community agencies to address critical gaps in how diabetes prevention interventions for obese Latino youth are developed, implemented and evaluated. This innovative approach is an essential step in the development of scalable, cost-effective, solution- oriented programs to prevent type 2 diabetes in this and other populations of high-risk youth.