Implementation of a Culturally-Grounded, Community Based Diabetes Prevention Program for Obese Latino Adolescents

Obesity and insulin resistance disproportionately effect Latino youth. Nearly 1/3 of obese Latino youth exhibit pre-diabetes and the CDC estimates that 50% of Latino youth will develop type 2 diabetes (T2D) during their lifetime. T2D is the result of a complex interaction between genetics and environment. However, even in genetically predisposed adults lifestyle modifications that include changes in nutrition and physical activity can be efficacious for preventing diabetes. Few diabetes prevention programs for youth have been reported in the literature and none have leveraged sociocultural factors and community influences, while also measuring specific biological markers that prelude T2D in obese Latino youth. Here we report preliminary data on the short-term efficacy and long-term sustainability of a culturally-grounded community based diabetes prevention intervention to support healthy behaviors and improve diabetes-related health outcomes among obese Latino youth.

Methods: A total of 160 obese (BMI ≥95^th percentile) Latino adolescents (age 14-16) will be randomized to a 12-week lifestyle intervention or control condition. The lifestyle intervention includes weekly diabetes education classes for groups of adolescents and their families and group exercise classes for adolescents (3 days/week for 60-min). The intervention is delivered in the community by bilingual/bicultural promotores (lay health workers) and exercise specialists. The intervention is framed within an adapted ecodevelopmental model that acknowledges the importance of multiple levels of influence (e.g. individual, family/peers, community, and culture) on health behaviors and outcomes. Behavioral change strategies including role modeling, goal setting, and enhancement of self-efficacy are implemented to support behavior change. Participants are assessed at baseline, 12-weeks, and 1-year for changes in nutrition behaviors, physical activity, and glucose tolerance in response to an Oral Glucose Tolerance Test (OGTT).

Results: Thus far, 105 participants have been enrolled with 58 randomized to the intervention condition. Youth who completed the 12-week intervention to date exhibit a significant improvement in glucose tolerance as evidenced by a 17% reduction in 2-hour glucose following the OGTT (122.9±3.5 to 102.2±4.2 mg/dl, p<0.001). Although attenuated, these health improvements have been maintained at the 12-month visit. Of particular interest are the 9 participants that exhibited pre-diabetes at baseline, most of whom (N=8), reverted to normal glucose tolerance by 12 months. In contrast, no significant diabetes-related changes were noted in the control group, and two participants who did not receive the intervention developed T2D within 1-year of enrollment.

Conclusions: These promising results provide preliminary support for the efficacy of a culturally-grounded diabetes prevention intervention to improve and maintain diabetes-related health outcomes in a vulnerable group of obese Latino youth.