Every Little Step Counts An Effective Model for Culturally Grounded Pediatric Diabetes Prevention
Learning Objectives • Define the impact of type 2 diabetes in the U.S. pediatric population • Recognize need for culturally grounded evidence based intervention for T2D in at risk pediatric population • Describe strategies for a successful diabetes prevention program in minority pediatric population
Content source: Centers for Disease Control and Prevention
Latino Youth • Conversion from prediabetes to T2D is accelerated during adolescence due to pubertal insulin resistance. 2 • Up to 50% of Latino children are projected to develop T2D in their lifetime 1
Complications • Physical Health Consequences – Insulin resistance – High BP – High Cholesterol – Polycystic ovary syndrome • Psychosocial Maladjustments – Lower quality of life – Increased premature mortality in adulthood – Depression 3 – Anxiety 3
Every Little Step Counts...
The Center for Family Wellness To improve the overall health and well-being of the community through disease management and prevention by providing education and counseling services for persons at risk or diagnosed with diabetes, focusing on long-term healthy lifestyle changes.
Every Little Step Counts
The Evolution 2015-2019 Pilot 2010-2012 2012-2017 Every Little Step Counts 2005
Conceptual Framework Contemporary Clinical Trials 54 (2017) 68-76 Castro J Behav Med 2009
Results • Feasibility – Could we actually do IT? • Acceptability – Would families ‘want’ IT? • Efficacy – Would IT work?
Changes in BMI Percentile 99 98.8 98.6 Control 98.4 BMI % 98.2 98 P=0.003 P=0.001 97.8 97.6 Intervention 97.4 97.2 97 Baseline 12-weeks 6-months 12-months
Changes in Percent Fat 48 47 Control 46 Total fat % 45 P<0.01 44 P<0.001 43 42 41 Intervention 40 Baseline 12-weeks 6-months 12-months
Glucose Tolerance Among Youth with IGT 160 150 P<0.05 P<0.05 2-hr Glucose (mg/dl) 140 P<0.001 130 120 110 100 Baseline 3-months 6-months 12-months
Processes • Vested Community Partners • Opportunities for funding • Shared expertise • Culture of trust and understanding • Mobilization of community of resources
The Evolution 2015-2019 2017-Today Pilot 2010-2012 2012-2017 Every Little Step Counts (2005)
Nutrition and PA
Outcomes- Parents 48 p = 0.001 5.8 p = 0.03 47 5.6 HbA1c (%) 46 Body Fat % 45 5.4 44 5.2 43 42 5 PRE POST PRE POST
Outcomes-Children p = N.S. 45 5.8 p = 0.03 44 5.6 HbA1c (%) Body Fat % 43 5.4 42 5.2 41 40 5 PRE POST PRE POST
Creating a Scalable Model for Pediatric Diabetes Prevention • Strategies – Community based outreach – Building capacity- workforce development – Collaboration- interinstitutional – Next generation approach
Creating a Scalable Model for Pediatric Diabetes Prevention • Next steps – Dissemination & Replication – National Model for Pediatric Diabetes Prevention – Workforce – Sustainability – Policy Content Source: Livewellaz.org
References 1. Soltero EG, Ramos C, Williams AN, et al. ¡Viva Maryvale!: A Multilevel, Multisector Model to Community-Based Diabetes Prevention. Am J Prev Med 2019;56(1):58−65 2. Soltero EG, Konopken YP, Olson ML, et al. Preventing diabetes in obese Latino Youth with prediabetes: A study protocol for a randomized controlled trial. BMC Public Health. 2017; 17: 261. doi: 10.1186/s12889-017-4174-2 3. Williams AN, Konopken YP, Keller CS, et al. Culturally-grounded diabetes prevention program for obese Latino youth: Rationale, design, and methods. Contemporary Clinical Trials . 54 (2017) 68 – 76. DOI: https://doi.org/10.1016/j.cct.2017.01.004 4. Prevent Type 2 Diabetes in Kids. https://www.cdc.gov/features/prevent- diabetes-kids/index.html. Published June 29 2017. Accessed May 13, 2019. 5. Haire-Joshu D, Hill-Briggs F. The Next Generation of Diabetes Translation: A Path to Health Equity. Annu. Rev. Public Health 2019.40:391-410.
QUESTIONS?
Maria Silva RDN, CDE msilva@svdpaz.org 602-850-6740 Manager l Center for Family Wellness Society of St. Vincent de Paul Phoenix, AZ
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