Family-centered diabetes program reduces risk factors in young American Indians

One-year findings include improvements in hypertension, BMI, and physical activity

Theme(s):
Nutrition Promotion and Obesity and Diabetes Prevention

New findings published in The Diabetes Educator this month show that a family-centered diabetes prevention and management program effectively decreased body mass index and high blood pressure in American Indian adolescents diagnosed or at risk for type 2 diabetes. This study is the first to examine the impact of a home-based intervention on diabetes prevention and management for American Indian youth.

Johns Hopkins Center for American Indian Health developed Together on Diabetes in partnership with the Navajo Nation and White Mountain Apache Tribe, with support from the Bristol-Myers Squibb Foundation.

Significant reductions in diabetes risk factors and increased physical activity in participating children, whose ages ranged between 10 and 19 years, were observed at six and 12 months after enrollment. Furthermore, results indicate that paraprofessionals—in this case, Family Health Coaches recruited from the Native communities—can feasibly implement and evaluate home-based diabetes prevention programs.

Immense burden of diabetes in young American Indians

Within the United States, American Indian youth experience the highest rate of childhood obesity and the highest of any racial/ethnic group. The occurrence of type 2 diabetes in adolescent American Indians more than doubled between 2001 and 2009. By 2009, American Indian adolescents were seven times more likely than white adolescents to have type 2 diabetes.

Progression of insulin resistance to type 2 diabetes is faster in obese children than in adults. Therefore, interventions that can effectively reduce obesity are urgently needed for the youth population and will help curb the rising health care costs of obesity.

Creating a healthy home environment

Together on Diabetes

Together on Diabetes works on multiple levels, including one-on-one home-based healthy living education and social support to youth with, or at risk of developing, type 2 diabetes. The program provides young people with problem-solving skills to improve psychosocial health and helps their caregivers create a healthy home environment. To increase participants’ understanding of diabetes and treatment compliance, the Family Health Coaches accompanied youth to provider visits, helped patients navigate the care system, and built relationships between providers, patients, and families. Family Health Coaches work during the second half of Together on Diabetes to ensure that after the program, a supportive adult, often a parent, can help the young person continue to make healthy lifestyle changes and comply with treatment.

“We are thrilled to document that a home-based diabetes prevention and management program developed by local and community health workers can change youth’s trajectories. The program works at a critical juncture for averting serious lifelong health consequences,” said Allison Barlow, PhD, MPH, director of the Johns Hopkins Center for American Indian Health and the study’s principle investigator.  

“I really enjoyed the program and my amazing Family Health Coach, who helped me through it,” said Shantel Battiest, 13. “I am living a healthier lifestyle now—I rarely drink soda, and I’m much more active,” she said.

Adapting this program in other tribes—and beyond

Based on early success with Together on Diabetes, the Johns Hopkins Center for American Indian Health partnered with the Chinle Indian Health Service Unit and Navajo Area Indian Health Service to create a school-based obesity and diabetes prevention initiative for local youth. The Center is working with additional tribes to adapt Together on Diabetes.

415 million people worldwide are living with diabetes today. By 2040, one in 10 people worldwide are projected to be living with diabetes. Global medical costs for diabetes are projected to increase from $375 billion in 2010 to $490 billion by 2030. With the demonstrated effectiveness of employing local paraprofessionals, the approach holds promise for other low-income communities with significant structural and cultural barriers to medical care.

For more information, contact Rose Weeks rweeks@jhu.edu  / 442-287-5152.

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