A Home-Visiting Approach to Prevention of Type 2 Diabetes Among American Indian Youth Reduces Sugar-Sweetened Beverage Consumption

Introduction: In the US, American Indian youth (AI) have the highest rates of childhood obesity and fastest growing rates of type 2 diabetes (T2DM). Changes in diet and physical activity have proven to be more effective than pharmaceutical treatments to prevent youth onset T2DM. SSBs are considered the largest source of added sugar in youth diets in the US. Studies have shown strong associations between sugar-sweetened beverage (SSB) consumption, childhood obesity and T2DM. In this study, we tested whether the “Together on Diabetes” (TOD) home-visiting and family support intervention impacted SSB consumption, a modifiable risk factor for childhood obesity and youth onset T2DM. We also examined whether SSB consumption differed by demographic or psychosocial factors.

Methods: The TOD intervention was tested using a single group pre/post study design in 4 southwestern reservation communities over 12 months. The intervention/protocols were developed using a Community Based Participatory Research approach. AI youth, 10 – 19 years old, who were diagnosed with or “at-risk” for T2DM were eligible to enroll in the study, with a family-based support person (SP) of their choice. Youth received 12 AI Family Health Coach (FHC) delivered lessons in the first 6 months and monthly maintenance visits for the remaining 6 months of the intervention. The youth’s SP was encouraged to attend these sessions and received an additional 4 lessons aimed at supporting the youth. FHCs also assisted with health provider visits and engaging participants in community health events. Youth’s demographic, psychosocial, behavioral and physiological data were collected at baseline, 3, 6, and 12 months to assess outcomes.

Results: 256 youth (44.1% girls, mean age: 13.58) enrolled between 2012-2014 across 4 sites. At baseline 13.2% of youth participants were diagnosed diabetic, 86.8% were pre-diabetic/at-risk, and 95.7% were overweight or obese. Previous analyses showed significant improvements in knowledge, psychosocial and physiologic outcomes. Multivariate results (mixed effects) from the current analysis augment those results, showing a statistically significant decrease between baseline and 12 months in weekly SSB consumption (μ=-1.39, p<0.0001). The results also showed that SSB consumption statistically significantly decreased in relation to the number of youth lessons received (μ=-0.18, range: 0-12, p=0.004), and increased with positive depression screening (μ=1.59, p=0.003), and increasing baseline age (μ=0.34, range: 10.00-19.84, p<0.0001).

Conclusion: The TOD home-visiting intervention successfully reduced SSB consumption, the greatest source of added sugar in our children’s diets. This is an important step towards curbing the obesity and T2DM epidemics.