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.

项目概要/摘要青少年发病的 2 型糖尿病 (T2D) 发病率迅速上升，特别是在以下年龄段的女性中：历史上处于不利地位的种族/族裔群体的预防至关重要，因为青少年发病的 T2D 经常表现出来。比成人发病更具侵袭性的病程，并且有效的治疗方案仍然难以捉摸。 T2D 预防的护理包括改善胰岛素抵抗的运动训练，胰岛素抵抗是一个关键的生理因素尽管运动训练有短期益处，但对青少年来说效果不够。值得注意的是，相当多的青少年存在患 T2D 的风险。抑郁症增加和体力活动减少，尤其是肥胖女性。随着时间的推移，抑郁症状可能会导致胰岛素抵抗恶化，与体重指数（kg/m2）无关通过压力介导的途径，例如减少体力活动和健身，青少年抑郁症也会发生。即使考虑到肥胖，也与体力活动和心肺健康减少有关，抑郁症预示着人们会更加不坚持运动训练。该提案的中心主题是：首先进行认知行为治疗 (CBT)，然后进行干预的干预顺序其次，运动训练将为改善胰岛素抵抗提供有针对性的有效策略因此，降低有抑郁症状的 T2D 风险的青少年女性的 T2D 风险。 NIH/NIDDK K99/R00 随机对照试验（RCT），我们发现 6 周组 CBT 减少抑郁症对患有 T2D 风险且抑郁程度中度升高的青少年女性进行 6 周随访，与为期 6 周的教育健康教育对照组，患有抑郁症的青少年被随机分配到对照组。与对照相比，CBT 在 1 年时的空腹和 2 小时胰岛素水平较低。我们的初步数据表明 CBT 的重点。关于提高身体活动的频率/享受来对抗抑郁情绪部分解释了原因减少抑郁症可以降低 T2D 风险目前尚不清楚 CBT 是否与标准护理锻炼一样有效。训练，或者 CBT 后进行运动训练是否可以最大程度地有效降低 T2D 风险有抑郁症状的 T2D 风险的青春期女性要解决这些差距并直接建立在我们的基础上。在之前的工作中，我们提出了一项四臂 RCT 来：（1）比较四个 6 周→6 周序列的疗效改善 N=300 名有罹患 T2D 风险且抑郁症状加重的青少年女性的胰岛素抵抗： (i) CBT→锻炼，(ii) 锻炼→CBT，(iii) 仅 CBT（CBT→继续 CBT），以及 (iv) 仅锻炼（锻炼→继续锻炼）；（2）评估身体活动/健身作为抑郁的中介因素- 胰岛素抵抗关联；(3) 评估减少抑郁症的潜在机制使用混合方法过程增加体力活动并改善健康和胰岛素抵抗评估结果将支持我们的长期目标，即确定可行的、具有成本效益的干预策略。向有抑郁症状且患有 T2D 风险的青少年有效传播的潜力很大。