A Randomised Controlled Trial Testing a Behavioural Intervention Program for the Prevention of Type 2 Diabetes Among American Indian Youth: The Tribal Turning Point Study

Abstract

Background: American Indian youth experience a high risk of overweight/obesity and type 2 diabetes. Objectives: To evaluate the effect of a behavioural intervention on diabetes risk factors among American Indian youth with overweight/obesity. Methods: Between 2018 and 2023, youth (7–10 years) were randomised to the tribal turning point (TTP) intervention (n = 87) or control arm (n = 95). Community coaches delivered the core intervention in the first 6 months (10 group classes, 4 individual sessions with motivational interviewing) followed by the booster intervention in the second 6 months (2 group classes, 3 individual sessions). The control arm received 4 health/safety classes over 12 months. Data were collected at baseline, 6, and 12 months. Co-primary outcomes were 12-month change in BMI and fasting insulin. Results: There were no significant differences by randomization for either primary outcome at 12 months. Among youth who completed 6-month assessments before the COVID-19 pandemic, the TTP intervention, compared to the control arm, was associated with significantly decreased change values for age/sex-adjusted BMI z-scores (p = 0.028) and waist circumference (p = 0.040) at 6 months. Conclusions: In this trial among American Indian youth spanning the COVID-19 pandemic, the TTP intervention yielded short-term improvements on obesity measures but only in the subset who participated before the pandemic.