Diabetes prevention in schools and communities

Abstract

This chapter considers the issue of type 2 diabetes (T2D) prevention in children and adolescents. We first discuss the epidemiology and treatment issues for youth with T2D and then review risk factors for the development of T2D, including obesity, family history of T2D, ethnic minority status, and behavioral factors such as sedentary behavior, low levels of physical activity, and poor dietary intake. There are few examples of studies addressing the primary prevention of T2D in children, but available evidence indicates that school-wide programming emphasizing healthy lifestyle habits may reduce adiposity and fasting glucose. Considerably more research has addressed secondary prevention efforts by intervening with youth at high risk for T2D. A number of controlled studies provide evidence supporting the benefits of interventions to improve dietary habits, increase physical activity, and reduce weight in obese youth and consequently reduce metabolic risk factors for T2D such as insulin resistance. While interventions have been delivered mostly in school or community clinic settings, some have also taken place in homes. More studies are needed to examine the efficacy of interventions delivered via telehealth to reduce T2D risk. The available evidence is promising but mostly consists of relatively small studies with limited follow-up. More randomized controlled trials with larger study samples are needed to demonstrate the efficacy of programs to reduce T2D risk in children of various ethnicities.