Similar Reductions in T2D Risk Factors Observed with Lifestyle Intervention, Usual Care

Gabriel Q. Shaibi, PhD

By increasing accessibility to prevention services among high-risk youths, there may be a subsequent reduction in type 2 diabetes (T2D) rates in underserved populations, as reported by a new trial in JAMA Network Open.

The study data suggest lifestyle interventions resulted in significant short- and long-term reductions in several risk factors for T2D that were not significantly different than usual care.

Yet, they did see an improvement in weight-specific quality of life (YQOL-W) at the 12-month follow-up.

“How to expand T2D prevention efforts for high-risk youths with prediabetes to meet the growing demands among underserved communities warrants additional consideration,” wrote study author Gabriel Q. Shaibi, PhD, Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University.

Study Methods

According to the US Centers for Disease Control and Prevention (CDC) estimated that Latino youths have a 50% lifetime risk of developing T2D. Lifestyle interventions are the first-line approach to prevention efforts among adults with prediabetes, based on the Diabetes Prevention Program (DPP), but few trials have described adapting the DPP to a high-risk pediatric population.

Due to the disproportionately high rate of prediabetes in Latino youths, there remains a need for a DPP adaptation to meet the specific needs of this group. Shaibi and colleagues thus tested the efficacy of a community-based lifestyle intervention compared with usual care among Latino youths with prediabetes and obesity.

A 2-group parallel randomized clinical trial assessed a lifestyle intervention (INT) with a usual care control (UCC) condition, with follow-up at 6- and 12-months. It was conducted at YMCA facilities in Arizona from May 2016 to March 2020.

The 6-month INT included 1 d/wk of nutrition and health education with behavior change skills training and 3 d/wk of physical activity. On the other hand, UCC included 2 visits with a pediatric endocrinologist and a bilingual, bicultural registered dietitian to discuss diabetes risks and healthy lifestyle changes.

Study Data

At the follow-up periods, investigators assessed insulin sensitivity, glucose tolerance, and weight-specific quality of life (YQOL-W) at 6- and 12-month follow-up. The study enrolled a total of 117 youths, with a mean age of 14 years and consisting of 47 girls (40%). Of this population, 79 youths were randomized to INT and 38 to UCC.

At the 6-month mark, the mean 2-hour glucose was significantly reduced in the INT group (-12 mg/dL; P = .002), but not the UCC group (-5 mg/dL; P = .31). The difference in change in 2-hour glucose between each group was not considered significant (mean difference, –7.2 [95% CI, -19.7 - 5.3] mg/dL; P = .26).

Then, at 12-months, both INT (mean, -15 mg/dL; P = .002) and UCC (mean, -15 mgdL; P = .005) groups had significant reductions in 2-hour glucose with no difference between groups (mean difference, -0.3 [95% CI, -14.5 to 14.1] mg/dL; P = .97).

Data show mean insulin sensitivity increased by 37% following INT (baseline: 1.9; 6 months: 2.6; P = .001) with similar increases after UCC (32%; baseline: 1.9; 6 months: 2.5, P = .09). These changes were again not considered significant (mean difference, 0.1 mg [95% CI, -0.7 to 0.9]; P = .79).

The investigators additionally found YQOL-W was significantly increased in INT (7%: baseline: 75; 6 months: 80; P = .006), but not in the UCC group (-3%; baseline: 75; 6 months: 73; P = .67).

There were no significant differences between groups, noted the investigators.

The study, “Effects of a Diabetes Prevention Program on Type 2 Diabetes Risk Factors and Quality of Life Among Latino Youths with Prediabetes: A Randomized Clinical Trial,” was published in JAMA Network Open.