Reducing risk factors for type 2 diabetes in American Indian youth: Tribal Turning Point

项目摘要 美国印第安人(土著)青年儿童2型糖尿病的发病率和患病率是所有儿童中最高的 美国的种族/民族群体。生活方式的改变已被证明可以预防2型糖尿病 在高危成年人中增加高达58%，包括土著人口，但在土著青年中也有类似努力 在很大程度上都不成功。我们最近开发了一种针对原住民青少年的行为干预--家长 二人组被称为部落转折点(TTP)。在一项随机的初步研究中，我们论证了该计划的可行性 多项肥胖措施的交付、土著利益相关者的可接受性以及显著的治疗效果。 我们现在建议进行一项随机对照试验，以严格评估TTP对糖尿病的效果 300名7~10岁城市和农村超重/肥胖青年危险因素分析 由印度卫生服务部门提供服务。在每个社区内，青年将随机参加TTP计划或 一个全面的健康和安全控制程序。多成分TTP干预是以青年为中心的 糖尿病预防计划的适应性，旨在通过改善活动来减少糖尿病危险因素 和饮食行为。为期12个月的干预包括12个主动学习小组班级，7个个人 青年/家长激励性访谈咨询会议，以及针对社区的资源工具箱。在这 试验中，我们将评估TTP对2型患者的人体测量、代谢和行为危险因素的影响 干预结束时(12个月)和随访1年后(24个月)发生糖尿病。着眼于 在广泛传播该计划的同时，我们还将收集与参与者相关因素的定性数据 在整个获奖期内的参与度、计划交付和可持续性潜力，这将指导 今后的执行工作。我们建议的具体目标是：1)评估TTP对 人体测量(主要：BMI；次要：BMI z评分、腰围)和代谢(主要：空腹 胰岛素；次级：血红蛋白A1c)12个月和24个月的糖尿病危险因素。2)检查TTP的效果 关于健康行为(饮食、体力活动)以及健康行为改善的程度 TTP对糖尿病危险因素的影响。3)探索个人、组织和社区层面的因素 与参与者参与度、计划实施和持续交付的潜力相关。

Project Summary American Indian (Native) youth have the highest incidence and prevalence of pediatric type 2 diabetes of all racial/ethnic groups in the United States. Lifestyle modification has been shown to prevent type 2 diabetes among high-risk adults by up to 58%, including among Native populations, but similar efforts in Native youth have been largely unsuccessful. We recently developed a behavioral intervention for Native youth-parent dyads called Tribal Turning Point (TTP). In a randomized pilot study, we demonstrated feasibility of program delivery, acceptability by Native stakeholders, and significant treatment effects for multiple obesity measures. We now propose to conduct a randomized controlled trial to rigorously evaluate the effect of TTP on diabetes risk factors in 300 overweight/obese Native youth aged 7-10 years who are living in urban or rural communities served by the Indian Health Services. Within each community, youth will be randomized to the TTP program or a general health and safety control program. The multi-component TTP intervention is a youth-centered adaptation of the Diabetes Prevention Program designed to reduce diabetes risk factors by improving activity and dietary behaviors. The 12-month intervention includes 12 active learning group classes, 7 individual youth/parent motivational interviewing counseling sessions, and community-specific resource toolboxes. In this trial, we will assess the effect of TTP on anthropometric, metabolic, and behavioral risk factors for type 2 diabetes at the end of the intervention (12mo) and after 1 year of follow-up (24mo). With an eye toward widespread dissemination of the program, we will also collect qualitative data on factors related to participant engagement, program delivery, and potential for sustainability throughout the award period, which will guide future implementation efforts. The specific aims of our proposal are: 1) Evaluate the effect of TTP on anthropometric (primary: BMI; secondary: BMI z-score, waist circumference) and metabolic (primary: fasting insulin; secondary: hemoglobin A1c) diabetes risk factors at 12 and 24 months. 2) Examine the effect of TTP on health behaviors (diet, physical activity) and the extent to which improvements in health behaviors mediate the effects of TTP on diabetes risk factors. 3) Explore individual, organizational, and community-level factors related to participant engagement, program implementation, and potential for sustained delivery.