Preventing Type 2 Diabetes in At-Risk Youth

描述（由申请人提供）：随着2型糖尿病（T2 DM）在年轻人中的患病率不断增加，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，必须开发和测试预防糖尿病的新方法。 在这项调查中，我们建议：（1）采用前瞻性、随机临床试验设计，确定以学校为基础、多方面干预的效果（营养和运动教育，应对技能培训，高级实践护士（APN）辅导，和基础设施的变化）对身体质量指数（BMI），胰岛素抵抗，肥胖，血脂，健康行为，抑郁症，和自我效能在内城青年T2 DM的高风险。 实验组在12个月内的反应将与那些接受延迟干预的年轻人进行比较。 (2)其次，我们将检查基线特征（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，我们将探讨青少年和家庭在预防2型糖尿病中管理肥胖和胰岛素抵抗的经验。 为了实现这些目标，我们将招收240名高风险的六年级中学生。 高风险定义为BMI >第85百分位数。 学校将被随机分配到实验或延迟干预条件下。 实验性干预是一个以社区为基础的多方面干预计划，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。 将在干预前以及干预后4个月和13个月收集数据，主要结局为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，儿童抑郁量表的青少年和健康促进生活方式的父母。 一个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ANOVA广义估计方程法和扎根理论方法。 预计这项重要而及时的研究将提供有价值的信息，以帮助青少年管理肥胖，并可能预防T2 DM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.