Together on Diabetes: Evaluation of a Pilot Diabetes Prevention and Management Program for American Indian Youth

Introduction:  American Indian (AI) youth have the highest and fastest growing rate of type 2 diabetes (T2D) of any ethnic group in the United States. Proven interventions targeting adults with or at risk for T2D are wide-spread, yet few interventions target AI youth. Recognizing the barriers to T2D treatment and prevention experienced by AI youth, Johns Hopkins Center for American Indian Health (JHCAIH) partnered with 4 AI communities in the Southwest US to design, implement and evaluate a diabetes prevention and management program for AI youth.

Methods: The Together on Diabetes (TOD) intervention promotes healthy lifestyle changes and care coordination for AI youth ages 10-19 with or at risk for T2D, and their families through a 12 session year-long home-visiting intervention delivered by well-trained AI paraprofessional Family Health Coaches (FHCs).  An additional 4-session curriculum is taught to a family-based support person, to help advance the youth’s behavior change goals. FHCs also attend medical appointments with youth and maintain communication with youths’ providers.  Knowledge, behavioral, physiological and psychosocial youth outcomes were evaluated at four time points (baseline, 3 months, 6 months and 12 months) using a single group pre-post study design.  

Results: Between 2012 and 2014, 255 youth and 223 support persons were enrolled across four sites.  At baseline, 15% (n=33) of youth had T2D, and 85% (n=188) were at-risk. Program retentions was high: 224 (88%) youth graduated and 167 (74.6%) received >8 lessons. Preliminary 12 month analyses indicate significant improvements in all four outcome domains (knowledge, behavioral, physiological and psychosocial). From baseline to 12 months, youth significantly increased knowledge related to TOD content (p<.001)and self-reported quality of life (p<.001); and decreased depressive symptoms (p<.001)and BMI-z scores (p=0.001). Youth and support persons reported high program satisfaction at 12 months.

Conclusions: TOD is an innovative, culturally-congruent program with significant impacts on broad-based risks for diabetic and pre-diabetic youth.  Results indicate the intervention’s family-based approach is feasible, acceptable and that local AI paraprofessionals could become an essential link to delivering diabetes prevention and management programs to high-risk families in under-resourced communities.  The TOD intervention and lessons has potential for dissemination to similar rural, low-resource communities throughout the US and the world.