Preventing Diabetes in Latino Youth

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, investigators 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. Investigators will further
test intervention effects on changes in quality of life, explore the potential mediating
effects of changes in total, regional, and 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 proposal 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.

Inclusion Criteria:

- Latino: self-report

- Age: 12-16

- Obese: BMI percentile ≥95th percentile for age and gender or BMI ≥30 kg/m22

- Prediabetic: fasting glucose ≥100 and/or 2-hour post-OGTT glucose ≥120 mg/dl

Exclusion Criteria:

- Taking medication(s) or diagnosed with a condition that influences carbohydrate
metabolism, PA, and/or cognition

- Type 2 diabetes: Fasting glucose ≥126 mg/dl or 2-hour glucose ≥200 mg/dl.

- Recent Hospitalization (previous 2 months)

- Currently enrolled in (or within previous 6 months) a formal weight loss program.

- Diagnosed depression or other condition that may impact QoL