As Pre-Diabetic Rates Rise, Collaborative Program Targets Youth
A UA-led team intends for EPIC Kids to serve as a model for community-based and youth-focused diabetes prevention, hoping that it will be implemented at YMCA locations across the country.
The federal government estimates that more than 5,000 people younger than age 20 are newly diagnosed each year with diabetes in the United States.
While many of the new cases are the autoimmune disease Type 1 diabetes, an increasing number are the more preventable Type 2, an illness previously seen only in adults. Also, about one in five children in the nation is obese, which is a strong risk factor for developing Type 2 diabetes.
Such figures are "astounding and terrifying," said Vivian Cullen of the YMCA of Southern Arizona, a member of the University of Arizona-led team that is pilot-testing EPIC (Encourage, Practice and Inspire Change) Kids. The diabetes prevention program, offered at two Tucson YMCA locations, is for children ages 9 to 12 — a group with increasing rates of Type 2 diabetes — and their families.
Led by UA researcher Melanie Hingle, the UA-YMCA team is teaching families how to help prevent diabetes through the program, which is poised to become a nationwide model for community-based and youth-focused diabetes prevention.
"Pre-diabetes, which is a term used to describe elevated fasting blood sugar, although not in the diabetes range, is much more prevalent than diabetes, and the majority of people who have pre-diabetes don't know that they have it," said Hingle, an assistant professor in the UA's Department of Nutritional Sciences. "Fortunately, it is completely preventable with a few key lifestyle behavior changes."
Hingle received National Institutes of Health funding to lead the design and implementation of EPIC Kids, which involves members of multiple UA colleges and a team of lifestyle coaches at the YMCA of Southern Arizona.
"Diabetes is a very disabling disease. It is a major public health problem," Hingle said, adding that 9 percent of children with Type 2 diabetes appear to have an accelerated version of the adult onset of the disease.
"We didn't see many children with Type 2 diabetes even 10 or 20 years ago, and we are particularly concerned with that. A lot of people do not think diabetes is preventable, which is alarming. This is a preventable disease."
EPIC Kids was modeled after the YMCA’s Diabetes Prevention Program for adults, a nationwide prevention program. This month, the YMCA of the USA reported that participants in the adult program averaged a loss of more than 5 percent of their weight after a year in the program. The organization also reported that individual savings for Medicare recipients, seen as part of the pilot program, amounted to $2,650 for those who participated.
Those are promising findings for Hingle and members of her team, who are working to address the pervasive public health and clinical concerns associated with increasing rates of Type 2 diabetes in youth.
Among adults, about 29.1 million people — more than 9 percent of the population nationwide — have diabetes, as reported in the 2014 National Diabetes Statistics Report, presenting public health and clinical challenges. The report also notes that diabetes resulted in $245 billion in direct and indirect costs in the U.S. in 2012 as a result of medical bills, disability, work loss and premature death.
The longer in life that a person has the condition, the greater the chances of cardiovascular disease, stroke and an overall decline in quality of life, Hingle said.
Hingle and Cullen noted that that onset of Type 2 diabetes in children has particular public health and clinical concerns. Of note, treatment in children is not very effective. The best approach thus far is prevention, by implementing dietary changes and motivating children to engage in exercise, which are two focal areas for EPIC Kids. Attention is given not merely to losing weight but also to adopting healthier lifestyles.
"When your 12-year-old has a diagnosis of high cholesterol and pre-diabetes, that will impact you in such a personal way," said Cullen, community outreach and Diabetes Prevention Program director at the YMCA of Southern Arizona.
"The YMCA is all about creating healthy families, but exercise and activity is not so much the norm anymore," Cullen said. "We've become very sedentary, and we don't always do things as families."
Focusing on preventing pre-diabetic conditions in youth who have at least one risk factor for diabetes, the EPIC Kids team engages children and their families in physically active and interactive activities led weekly by trained YMCA lifestyle coaches. Participants in the 12-week program also learn about healthful eating, and they are taught strategies for reducing sedentary time and for boosting family time and quality sleep.
"It's pretty shocking to see a 9-year-old with elevated cholesterol and blood pressure — but that's what's happening," Hingle said, noting that a child's lifestyle behaviors, body weight and biomarkers were considered when judging risk factors.
Unlike many programs that are offered in a school setting, EPIC Kids was launched in the community, building on the UA’s long-standing partnerships with the YMCA and opportunities to more readily involve families, Hingle said.
"Parents are key to behavioral changes in children, especially in the home, and they can also benefit from engaging," Hingle said.
"Risk factors for diabetes can emerge early in life, which is why we are doing our intervention now," she said. "It is difficult and expensive to treat chronic illness. If we can prevent or delay the onset of diabetes, we can potentially save them a lifetime of major losses and financial burdens, and also help them to maintain a high quality of life."
The EPIC Kids Study is supported by the National Institute of Diabetesand Digestive and Kidney Diseases of the National Institutes of Health under award number R21DK100805.
Other UA collaborators on the grant are:
- Randa Kutob, an associate professor in the College of Medicine's Department of Family Medicine
- Denise Roe, a professor in the Mel and Enid Zuckerman College of Public Health
- Craig Stump, an associate professor in the College of Medicine's Diabetes Program
- Nirav Merchant, information technology director at the Arizona Research Laboratories and a BIO5 Institute member
- Scott Going, head of the Department of Nutritional Sciences in the College of Agriculture and Life Sciences
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