Depression and Insulin Sensitivity in Adolescents

青少年的抑郁和胰岛素敏感性

基本信息

批准号：
9494565
负责人：
LAUREN BERGER SHOMAKER
金额：
$ 55.32万
依托单位：
COLORADO STATE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-06-01 至 2022-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9494565
关键词：
Accelerometer Accounting Address Adolescence Adolescent Adolescent obesity Adrenal Gland Hyperfunction Adult Affect Aftercare Aggressive course Award Behavior Behavioral Beta Cell Cell physiology Child Circadian Rhythms Cognitive Communities Comorbidity Consultations Control Groups Data Depressive disorder Deterioration Diabetes Mellitus Diabetes prevention Disadvantaged Disease Doctor of Philosophy Eating Ethnic group Face Failure Family Family history of Female Adolescents Goals Health Health education Healthcare High Prevalence Human Hydrocortisone Insulin Insulin Resistance Intervention Knowledge Link Longevity Mediator of activation protein Medicine Mental Depression Mission Modeling Non-Insulin-Dependent Diabetes Mellitus Obesity Outcome Output Overweight Pathogenesis Physical activity Physiological Physiology Play Population Prevention Psychosocial Stress Puberty Public Health Randomized Controlled Trials Recording of previous events Research Risk Risk Factors Role Scientist Sleep Sleep disturbances Stress Structure Structure of beta Cell of islet Symptoms Testing Time United States National Institutes of Health Work cardiometabolic risk cardiometabolism child depression cost effective depressive symptoms diabetes risk early onset effective intervention ethnic diversity experience follow-up girls high risk high-risk adolescents improved innovation insulin secretion insulin sensitivity lifestyle intervention moderate-to-vigorous physical activity modifiable risk multidisciplinary physical inactivity prevent program costs programs prospective psychosocial racial and ethnic response sedentary statistics stress symptom symptomatic improvement theories young adult

项目摘要

Project Summary/Abstract There has been rapid escalation of type 2 diabetes (T2D) rates in adolescents. Early-onset T2D (<20y) typically shows a more aggressive course than adult-onset T2D and disproportionately affects girls from disadvantaged, racial/ethnic groups. This group of girls also is at heightened risk for depression, and depression and T2D are linked. Depressive symptoms often manifest in adolescence and are a prospective risk factor for worsening of insulin sensitivity, the major physiological precursor—in combination with deterioration of pancreatic β-cell ca- pacity to secrete insulin—in the path to T2D. The effects of depression on poor insulin sensitivity remain even after accounting for adiposity. In theory, depressive symptoms may worsen insulin sensitivity through stress- induced behaviors (e.g., disinhibited eating, [physical inactivity], sleep disturbance) and stress-induced phys- iological causal mechanisms (e.g., hypercortisolism). The central theme of our proposal is that intervening to reduce depressive symptoms in adolescents at-risk for T2D may offer an innovative, targeted approach to ame- liorate insulin resistance and to, consequently, preserve β-cell function and lessen T2D risk. In preliminary data from an NIH K99/R00 Award, the PI found initial evidence that a 6-week cognitive-behavioral group decreased depressive symptoms and prevented worsening of insulin sensitivity 1 year later in overweight and obese girls with moderate depressive symptoms and a family history of T2D, in comparison to a 6-week health education control group. Directly extending these findings, the aims of this R01 proposal are: 1) to assess the efficacy of a 6-week cognitive-behavioral depression group vs. a 6-week health education control group for improving insulin sensitivity and preserving β-cell function in racially/ethnically diverse adolescent girls at-risk for T2D with mod- erate depressive symptoms over a 1-year follow-up; 2) to evaluate changes in eating, [physical activity], and sleep as behavioral explanatory mediators underlying the relationship between decreases in depressive symp- toms and improvements in insulin sensitivity and β-cell function over 1 year and 3) to test changes in cortisol awakening response, diurnal cortisol rhythm, and total daily cortisol output as physiological mechanisms explain- ing the relationship between decreases in depressive symptoms and improvements in insulin sensitivity and β- cell function over 1 year. We have assembled a strong, multidisciplinary team of scientists with expertise in depression, obesity, eating (PI: Lauren Shomaker, PhD), [child and adolescent insulin sensitivity and secre- tion] (Co-I: Kristen Nadeau, MD, MS), [puberty, precursors of early-onset T2D] (Co-I: Megan Kelsey, MD, MS), and statistics (Co-I: Sangeeta Rao, PhD), as well as consultation from experts on [ambulatory physical activity monitoring (Andrea Kriska, PhD, MS)], sleep medicine (Kenneth Wright Jr, PhD), [and adolescent depression (Eric Stice, PhD)]. Our long-term goal is to identify feasible, cost-effective public health solutions that have high potential for effective dissemination in communities at-risk for cardiometabolic disease and to understand the mechanisms by which alleviating psychosocial stress facilitates more positive health outcomes.

项目概要/摘要青少年中 2 型糖尿病 (T2D) 发病率通常迅速上升（<20 岁）。显示出比成人发病的 T2D 更具侵略性的病程，并且不成比例地影响来自弱势群体的女孩，种族/族裔群体也有罹患抑郁症的风险，而抑郁症和 T2D 也是如此。抑郁症状通常出现在青春期，并且是病情恶化的潜在危险因素。胰岛素敏感性，主要的生理前兆——与胰腺 β 细胞的恶化相结合胰岛素分泌能力下降——导致 2 型糖尿病 (T2D) 抑郁症对胰岛素敏感性差的影响仍然均匀。理论上，抑郁症状可能会因压力而恶化胰岛素敏感性。诱发的行为（例如，饮食不节制、[缺乏身体活动]、睡眠障碍）和压力诱发的身体活动我们建议的中心主题是干预生理因果机制（例如，皮质醇增多症）。减少有 T2D 风险的青少年的抑郁症状可能会提供一种创新的、有针对性的方法来治疗初步数据显示，它可以减轻胰岛素抵抗，从而保护 β 细胞功能并降低 T2D 风险。根据 NIH K99/R00 奖，PI 发现了初步证据，表明为期 6 周的认知行为组有所下降超重和肥胖女孩的抑郁症状并可防止一年后胰岛素敏感性的延长与 6 周健康教育相比，有中度抑郁症状和 T2D 家族史直接扩展这些发现，该 R01 提案的目的是：1) 评估某项研究的有效性。 6周认知行为抑郁组与6周健康教育对照组在改善胰岛素方面的比较具有 2 型糖尿病风险的种族/族裔多样化青春期女孩的敏感性和保留 β 细胞功能评估 1 年随访期间的抑郁症状；2) 评估饮食、[体力活动]和的变化；睡眠作为抑郁症状减少之间关系的行为解释性中介因素一年内胰岛素敏感性和 β 细胞功能的改善以及 3) 测试皮质醇的变化觉醒反应、昼间皮质醇节律和每日皮质醇总输出作为生理机制解释- 研究抑郁症状减少与胰岛素敏感性和β-改善之间的关系我们组建了一支强大的多学科科学家团队，在一年多的时间里对细胞功能进行了研究。抑郁、肥胖、饮食（PI：Lauren Shomaker 博士）、[儿童和青少年胰岛素敏感性和分泌] 和 MS）和统计数据（Co-I：Sangeeta Rao，博士），以及[动态身体检查专家的咨询] 活动监测（Andrea Kriska，博士，硕士）]，睡眠医学（Kenneth Wright Jr，博士），[和青少年抑郁症（埃里克·斯蒂斯博士）]我们的长期目标是找到可行的、具有成本效益的公共卫生解决方案。具有在有心脏代谢疾病风险的社区中有效传播的巨大潜力缓解社会心理压力促进更积极的健康结果的机制。