Type 2 diabetes among adults is a major public health issue in the United States, and it is rapidly becoming so among children and adolescents. Indeed, over one-third of children are overweight and nearly 1 in 5 obese. Concomitant with increased pediatric obesity, type 2 diabetes (T2D) has increased in youth (greater than 30% between 2001 and 2012), foreshadowing an earlier age of onset of T2D. Without effective intervention, the number of youth with T2D is expected to quadruple by 2050 resulting in an unprecedented health and financial burden on millions of Americans. To address the critical need for effective diabetes prevention programs that target at risk youth, our objective is to test the feasibility of integrating a family-focused lifestyle behavior change intervention within a Federally Qualified Health Center (FQHC) to reduce risk of incident T2D. The FQHC that will participate in this project serves those among the highest risk of diabetes: low income, Latino families. Building upon previous work in which the investigators independently demonstrated the benefits of YMCA-based, family-focused approaches in T2D prevention, we will adapt a successful YMCA-based diabetes program for delivery to mothers and their 8-12-year-old children by trained FQHC health and wellness staff. In order to determine potential for long-term program sustainability within this novel healthcare setting, we will evaluate program acceptability, implementation, integration with FQHC infrastructure, cost, and potential for expansion and maintenance. Preliminary impact of the 16-week family-focused intervention on diabetes and CVD risk factors (weight status, glucose control, lifestyle behaviors) will be assessed in 60 mother-child dyads participating in the 16-week group-randomized trial. Women who are at risk of T2D (based on metabolic phenotype and medical history) and their 8-12-yr-old child will be recruited to participate. While all 60 dyads will begin the study simultaneously, 30 mother-child dyads will participate as wait-listed controls until the other 30 dyads complete the intervention (after which they will also participate in the intervention). The proposed study is significant for its focus on reducing obesity and T2D prevalence in Latino children and women at risk using a family-focused, community-based approach that leverages parent involvement and our partner FQHC?s network of facilities, professionals, and resources. The proposed study is innovative in that it is the first to address T2D risk of mother and child simultaneously using the concept of ?primordial prevention,? wherein parents are activated to modify the social and physical environment to halt risk transmission to their offspring. It is novel in its engagement of mothers with metabolic phenotypes associated with T2D and known risk transmission to offspring (gestational diabetes mellitus), and leverages the combined work of the principal investigators to make family-based T2D prevention a reality for populations disproportionately burdened by this disease.
The goal of this project is to test the feasibility and acceptability of a family-focused lifestyle behavior change intervention delivered to mothers with prediabetes and their 8-12-year-old children by staff at a Federally Qualified Health Center (FQHC). The program, designed to prevent new cases of diabetes in at risk Latino women and children, will be adapted from the investigators? previous successful community-based type 2 diabetes prevention programs. The preliminary impact of the intervention on mother and child weight status, blood glucose levels, and lifestyle behaviors, will also be explored and resulting data will inform the design of a larger future study. The long-term goal is a scalable, replicable, and sustainable community-based program to effectively address obesity and type 2 diabetes in Latino youth, an underserved and growing population.
