A school-based intervention for diabetes risk reduction.
BACKGROUND
We examined the effects of a multicomponent, school-based program addressing risk factors for diabetes among children whose race or ethnic group and socioeconomic status placed them at high risk for obesity and type 2 diabetes.


METHODS
Using a cluster design, we randomly assigned 42 schools to either a multicomponent school-based intervention (21 schools) or assessment only (control, 21 schools). A total of 4603 students participated (mean [+/- SD] age, 11.3 [+/- 0.6 years; 54.2% Hispanic and 18.0% black; 52.7% girls). At the beginning of 6th grade and the end of 8th grade, students underwent measurements of body-mass index (BMI), waist circumference, and fasting glucose and insulin levels.


RESULTS
There was a decrease in the primary outcome--the combined prevalence of overweight and obesity--in both the intervention and control schools, with no significant difference between the school groups. The intervention schools had greater reductions in the secondary outcomes of BMI z score, percentage of students with waist circumference at or above the 90th percentile, fasting insulin levels (P=0.04 for all comparisons), and prevalence of obesity (P=0.05). Similar findings were observed among students who were at or above the 85th percentile for BMI at baseline. Less than 3% of the students who were screened had an adverse event; the proportions were nearly equivalent in the intervention and control schools.


CONCLUSIONS
Our comprehensive school-based program did not result in greater decreases in the combined prevalence of overweight and obesity than those that occurred in control schools. However, the intervention did result in significantly greater reductions in various indexes of adiposity. These changes may reduce the risk of childhood-onset type 2 diabetes. (Funded by the National Institutes of Health and the American Diabetes Association; ClinicalTrials.gov number, NCT00458029.)
Foster
Gary D
GD
Linder
Barbara
B
Baranowski
Tom
T
Cooper
Dan M
DM
Goldberg
Linn
L
Harrell
Joanne S
JS
Kaufman
Francine
F
Marcus
Marsha D
MD
Treviño
Roberto P
RP
Hirst
Kathryn
K
D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D002648:Child; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control*; D005260:Female; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007328:Insulin / Q000097:blood; D008297:Male; D052756:Nutritional Sciences / Q000193:education; D009765:Obesity / Q000453:epidemiology / Q000517:prevention & control; D050177:Overweight / Q000453:epidemiology / Q000517:prevention & control*; D010806:Physical Education and Training; D015995:Prevalence; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012572:School Health Services; D040241:Social Marketing
D001786:Blood Glucose; D007328:Insulin