Cognitive-Behavioral Therapy and Exercise Training in Adolescents At-Risk for Type 2 Diabetes

对有 2 型糖尿病风险的青少年进行认知行为治疗和运动训练

基本信息

批准号：
10806673
负责人：
LAUREN BERGER SHOMAKER
金额：
$ 13.42万
依托单位：
COLORADO STATE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-04-01 至 2027-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10806673
关键词：
Accounting Address Adherence Adolescence Adolescent Adult Affect Aftercare Behavior Therapy Body mass index Chronic Disease Cognitive Therapy Communities Control Groups Data Depressed mood Diabetes prevention Disadvantaged Disease Effectiveness Ethnic Origin Ethnic Population Exercise Fasting Female Female Adolescents Frequencies Goals Health Health education Healthcare Hour Individual Insulin Insulin Resistance Intervention Interview Life Expectancy Mediating Mediator Mental Depression Mental Health Metabolic Methods Mission National Institute of Diabetes and Digestive and Kidney Diseases Non-Insulin-Dependent Diabetes Mellitus Obesity Outcome Pathway interactions Persons Phenotype Physical Fitness Physical activity Physiological Prevention Prevention strategy Public Health Quality of life Race Randomized Randomized, Controlled Trials Research Risk Stress Teenagers Time United States National Institutes of Health Work Youth arm attentional control cardiorespiratory fitness center for epidemiological studies depression scale child depression combat comorbidity comparative efficacy cost cost effective cost effective intervention depressive symptoms diabetes risk effective therapy efficacious intervention efficacy study exercise training experience fitness follow-up improved insulin sensitivity physical inactivity post intervention process evaluation programs racial population sedentary socioeconomics standard of care

项目摘要

Project Summary/Abstract There has been rapid escalation in adolescent-onset type 2 diabetes (T2D), particularly in females from historically disadvantaged racial/ethnic groups. Prevention is critical because adolescent-onset T2D often shows a more aggressive disease course than adult-onset, and effective treatment options remain elusive. Standard- of-care for T2D prevention includes exercise training to ameliorate insulin resistance, a key physiological precursor to T2D. Despite short-term benefits, exercise training shows insufficient effectiveness in adolescents at-risk for T2D. Depression may be explanatory in a considerable subset of teenagers. Adolescence is notable for increases in depression and decreases in physical activity, especially in females with obesity. Youths' depression symptoms contribute to worsening insulin resistance over time, independent of BMI (kg/m2), likely through stress-mediated pathways such as reduced physical activity and fitness. Also, adolescent depression is associated with decreased physical activity and cardiorespiratory fitness, even after accounting for adiposity, and depression predicts greater non-adherence to exercise training. The central theme of this proposal is that an intervention sequence of delivering cognitive-behavioral therapy (CBT) first, followed by intervening with exercise training second, will offer a targeted, efficacious strategy for improving insulin resistance and consequently, lowering T2D risk in adolescent females at-risk for T2D with depression symptoms. In a prior NIH/NIDDK K99/R00 randomized controlled trial (RCT), we found that 6-week group CBT decreased depression at 6-week follow-up in adolescent females at-risk for T2D with moderately elevated depression, compared to a 6-week didactic health education control group. Adolescents with elevated depression who were randomized to CBT had lower fasting and 2-hour insulin at 1-year vs. controls. Our preliminary data suggest that CBT's focus on enhancing frequency/enjoyment of physical activity to combat depressed mood partially explained why decreasing depression lowered T2D risk. It is not known if CBT is just as efficacious as standard-of-care exercise training, or whether CBT followed by exercise training results in a maximally potent alleviation of T2D risk in adolescent females at-risk for T2D with depression symptoms. To address these gaps and directly build on our prior work, we propose a four-arm RCT to: (1) Compare the efficacy of four 6-week6-week sequences for improving insulin resistance in N=300 adolescent females at-risk for T2D with elevated depression symptoms: (i) CBTexercise, (ii) exerciseCBT, (iii) CBT only (CBTcontinue CBT), and (iv) exercise only (exercisecontinue exercise); (2) Evaluate physical activity/fitness as mediators underlying the depression- insulin resistance association; and (3) Evaluate underlying mechanisms by which decreasing depression increases physical activity and improves fitness and insulin resistance using a mixed-methods process evaluation. Findings will support our long-term goal to identify feasible, cost-effective intervention strategies with high potential for effective dissemination to adolescents at-risk for T2D with elevated depression symptoms.

项目摘要/摘要青少年发作2型糖尿病（T2D）的迅速升级，尤其是在女性中历史上处于不利地位的种族/族裔群体。预防是至关重要的，因为青少年发作的T2D经常显示比成人发作的更具侵略性的疾病病程，有效的治疗方案仍然难以捉摸。标准- 预防T2D的护理包括运动训练以改善胰岛素抵抗，这是关键的生理 T2D的前体。尽管有短期的益处，但运动训练表明青少年的有效性不足 T2D处于危险中。抑郁症可能是在青少年的考虑子集中被剥夺的。青少年是著名的为了增加抑郁症和体育锻炼的减少，尤其是在肥胖女性中。青年抑郁符号随着时间的推移有助于担心胰岛素抵抗，与BMI无关（kg/m2），可能通过应力介导的途径，例如降低体育活动和适应性。而且，青春期抑郁症是即使考虑到肥胖，也与体育锻炼减少和心肺健康有关和抑郁预测运动训练更大。该提议的中心主题是首先提供认知行为疗法（CBT）的干预顺序，然后介入第二锻炼训练第二，将提供有针对性的，有效的策略来改善胰岛素抵抗和因此，降低了患有抑郁症状的T2D的青春期女性T2D风险。在先前 NIH/NIDDK K99/R00随机对照试验（RCT），我们发现6周组CBT减少了抑郁症在青春期女性的6周随访中，T2D的抑郁症中等抑郁症的T2D随访为期6周的教学教育对照组。抑郁症升高的青少年被随机地与对照相比，CBT的禁食较低和2小时的胰岛素。我们的初步数据表明CBT的重点关于增强体育锻炼的频率/享受以应对沮丧的情绪，部分解释了为什么减少抑郁症降低了T2D风险。尚不清楚CBT是否像护理标准练习一样高效培训，或CBT进行锻炼训练是否会导致最大的潜在减轻T2D风险 T2D的青春期女性患有抑郁症状。解决这些差距并直接建立在我们的基础上先前的工作，我们提出了一个四臂RCT：（1）比较为期6周的6周序列的效率提高n = 300名青春期女性的胰岛素耐药性，抑郁症状升高的T2D风险：（i）CBT运动，（ii）练习CBT，（iii）仅CBT（CBTCBT），并且（iv）仅运动（运动练习）；（2）评估体育锻炼/适应性，作为抑郁症的介体胰岛素抵抗关联；（3）评估降低抑郁症的基本机制增加体育锻炼，并使用混合方法提高健身和胰岛素抵抗评估。调查结果将支持我们的长期目标，以确定可行的，具有成本效益的干预策略有效传播抑郁症状的T2D的青少年有效传播的高潜力。