Pilot Diabetes Prevention Study Shows A1C Drops in At-Risk Youth

A pilot project that tested a lifestyle modification program on 33 poor, mostly Hispanic youth successfully helped nearly half of them bring their glycated hemoglobin (A1C) under control, according to a report appearing this week in Diabetes Care.

The small study was led by researchers at the University of Tennessee in Memphis, a city with one of the nation’s highest rates of childhood obesity. The pilot tested a program called Insulin Superheroes Club, a modified version of the Diabetes Prevention Program (DPP) designed for children from culturally diverse, minority backgrounds. CDC data show that children who are overweight are at increased risk of developing obesity and diabetes as adults, and poor children are at increased risk for both. The mean age of the children in the pilot was 10.8 years.

The program’s design captured children who had a parent with impaired glucose tolerance who was simultaneously enrolled in the DPP; the “superheroes club” has a similar yearlong design to the CDC-recognized program for adults: an initial phase of 16 weekly classes, 3 biweekly classes, followed by 6 monthly classes.

The youth participants took 60 minutes of physical activity and 30 minutes of education, which included lessons in nutrition, physiology, mindfulness, exercise, and stress reduction. Children took hands-on cooking classes and engaged in role play, while also learning specific exercises, playing basketball, or taking part in dance or yoga.

All 33 youth who started the pilot had low socioeconomic status, including 76% receiving government food assistance. They were 59% female and 88% Hispanic, and they came from 16 households, so most had a sibling in the program in addition to having a parent enrolled in the DPP. More than half the group were at least overweight, meaning they had a body mass index (BMI) of at least 25 kg/m²; 24% were overweight (BMI 25 to < 30 kg/m²) while 39% were obese (BMI 30 30 kg/m² or higher). Five youth were lost to follow-up, but their baseline A1C was similar to the rest of the group.

From baseline to the 16-week mark, A1C for the remaining youth improved significantly; the percent with an A1C 5.7% or higher dropped from 61% to 15%. Measures of BMI, body fat, diastolic blood pressure, a right-hand grip test, and a 6-minute walk test all improved to a lesser degree. Results at the 12-month mark will be reported later.

“The beneficial outcomes suggest that a family-based program that involves lifestyle education, behavior modification, and goal-driven exercise can be effective in a predominantly Latino population,” the authors wrote.

Reference

Mantillo C, Jones T, Decker KM, et al. Diabetes prevention program in youth (Insulin Superheroes Club) pilot: improvement in metabolic parameters and physical fitness after 16 weeks of lifestyle intervention [published March 21, 2017]. Diabetes Care. 2017;. https://doi.org/10.2337/dc16-2678