Type 2 diabetes (T2D) has emerged among adolescents, particularly American Indian (AI) youth. The Diabetes Prevention Program (DPP) provides a strong efficacy base for primary prevention through moderate weight loss and physical activity. However studies to date among high risk youth have had very limited success. Our overarching goal is to develop, deliver and rigorously evaluate a novel three-component intervention to reduce risk for T2D in AI youth. The intervention is designed for broad, sustainable dissemination and implementation, using a structure of core content with exchangeable, tribe-specific modules and detailed manuals to facilitate high fidelity implementation. Our objectives for this application are a) to further develop a translational intervention called the Tribal Turning Point Program (TTPP) and b) to generate data to inform an R18 application. The TTPP targets diet and physical activity through: 1) motivational interviewing (MI) for child/parent dyads to facilitate problem solving and behavioral goal attainment;2) a translational, culturally appropriate active-learning modification of the DPP for AI parents and youth delivered in a group setting;and 3) a culturally appropriate Turning Point Toolbox to support the MI and active learning components, based on the social ecologic model. We have established a partnership between Cherokee and Navajo, supported by the University of North Carolina, the University of Colorado Denver (UCD), the UCD-based Center for American Indian and Alaska Native Diabetes Translational Research (CAIANDTR), and a diverse Advisory Board. Together we propose the following Aims:
Aim 1 (Year 1): To further develop the TTPP through a community-based participatory research process to ensure 1) fidelity with the DPP-based foundation;2) consistency with evidence from the pediatric weight management literature;and 3) capacity for adoption by other AI communities for sustainable program delivery.
Aim 2 (Years 1 and 2): To ensure eventual wide dissemination and sustainable implementation across multiple AI communities through a partnership with Indian Health Service (IHS)-sponsored Special Diabetes Program for Indians (SDPI) demonstration projects.
Aim 3 (Year 2): To conduct an 8-month pilot and feasibility trial of the TTPP, among 30 overweight or obese AI youth with a parent or other primary caregiver in each of two sites (Cherokee and Navajo, total n=60 youth age 8-10yr), randomized to intervention or control. Primary outcomes are BMI and fasting insulin concentration. Results will inform a fully powered randomized clinical trial to be proposed in an R18 application shortly following completion of the R34 pilot and feasibility study. Advancement of the Tribal Turning Point Program through this translational research process will provide a critical extension of the successes of the SDPI programs in adults to address the compelling need to reduce risk of T2D among AI youth.

Public Health Relevance

Strong data are available that support the efficacy of lifestyle approaches to reduce risk for type 2 diabetes (T2D) in adults, most notably from the NIH-funded Diabetes Prevention Program. American Indian youth are at remarkably high risk for T2D, yet from a recent systematic review, there is a stunning dearth of high quality intervention research related to T2D among indigenous populations. Thus, the significance of the proposed work is to address this major gap and substantially inform the translation of the efficacy base to effective T2D primary prevention for AI youth.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Planning Grant (R34)
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Special Emphasis Panel (ZDK1-GRB-1 (J1))
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Hunter, Christine
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University of North Carolina Chapel Hill
Schools of Public Health
Chapel Hill
United States
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