Physician-directed primary care intervention to reduce risk factors for type 2 diabetes in high-risk youth

Background: The incidence of type 2 diabetes in youth is increasing at an alarming rate. The purpose of this pilot study was to determine whether a nutrition and physical activity intervention in an urban primary care office is feasible and effective in decreasing risk factors for type 2 diabetes in high-risk youth. Methods: A one-group pretest/post-test design was used. Participants were recruited from existing patients in a primary care facility serving low-income children. Inclusion criteria included body mass index (BMI) over the 85th percentile for age and a fasting glucose-insulin ratio (FGIR) less than 6. Thirty-six African-American patients, 9 males, 27 females, average age 12.4 years (range, 8-18) participated in a 12-week nutrition and physical activity program. Measurements included fasting glucose, insulin, FGIR, lipid profile, blood pressure, and BMI. BMI and laboratory values were tested for significant differences before and after intervention using paired t-tests. A P-value of <.05 was considered statistically significant. Results: On average, patients attended 8.3 of 24 physical activity sessions, 2 of 3 nutrition sessions and 1.5 of 3 planned clinical sessions. Twenty-six of 36 patients completed follow-up laboratory tests. Mean FGIR improved significantly from baseline (3.6 +/- 1.2 to 4.6 +/- 2.8; P = .043). Conclusions: A nutrition and physical activity intervention for overweight children can be conducted in an urban primary care setting and may decrease laboratory evidence of insulin resistance, a risk factor for type 2 diabetes. Making the program accessible by public transit and scheduling the sessions at convenient times were important factors.