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1. Effect of Metformin and Lifestyle Interventions on Mortality in the Diabetes Prevention Program and Diabetes Prevention Program Outcomes Study

Author

Lee, Christine G, Heckman-Stoddard, Brandy, Dabelea, Dana, Gadde, Kishore M, Ehrmann, David, Ford, Leslie, Prorok, Philip, Boyko, Edward J, Pi-Sunyer, Xavier, Wallia, Amisha, Knowler, William C, Crandall, Jill P, Temprosa, Marinella, Group:, Diabetes Prevention Program Research, Bray, George A, Culbert, Iris W, Arceneaux, Jennifer, Chatellier, Annie, Dragg, Amber, Champagne, Catherine M, Duncan, Crystal, Eberhardt, Barbara, Greenway, Frank, Guillory, Fonda G, Herbert, April A, Jeffirs, Michael L, Kennedy, Betty M, Levy, Erma, Lockett, Monica, Lovejoy, Jennifer C, Morris, Laura H, Melancon, Lee E, Ryan, Donna H, Sanford, Deborah A, Smith, Kenneth G, Smith, Lisa L, St. Amant, Julia A, Tulley, Richard T, Vicknair, Paula C, Williamson, Donald, Zachwieja, Jeffery J, Polonsky, Kenneth S, Tobian, Janet, Ehrmann, David A, Matulik, Margaret J, Temple, Karla A, Clark, Bart, Czech, Kirsten, DeSandre, Catherine, Dotson, Brittnie, Hilbrich, Ruthanne, McNabb, Wylie, Semenske, Ann R, Caro, Jose F, Furlong, Kevin, Goldstein, Barry J, Watson, Pamela G, Smith, Kellie A, Mendoza, Jewel, Simmons, Marsha, Wildman, Wendi, Liberoni, Renee, Spandorfer, John, Pepe, Constance, Donahue, Richard P, Goldberg, Ronald B, Prineas, Ronald, Calles, Jeanette, Giannella, Anna, Rowe, Patricia, Sanguily, Juliet, Cassanova-Romero, Paul, Castillo-Florez, Sumaya, Florez, Hermes J, Garg, Rajesh, Kirby, Lascelles, Lara, Olga, Larreal, Carmen, McLymont, Valerie, Mendez, Jadell, Perry, Arlette, Saab, Patrice, Veciana, Bertha, Haffner, Steven M, Hazuda, Helen P, Montez, Maria G, Hattaway, Kathy, Isaac, Juan, Lorenzo, Carlos, Martinez, Arlene, Salazar, Monica, Walker, Tatiana, Hamman, Richard F, Nash, Patricia V, Steinke, Sheila C, Testaverde, Lisa, Truong, Jennifer, and Anderson, Denise R

Subjects
Biomedical and Clinical Sciences, Public Health, Health Sciences, Clinical Sciences, Prevention, Clinical Trials and Supportive Activities, Nutrition, Clinical Research, Cancer, Cardiovascular, Diabetes, Aetiology, 2.2 Factors relating to the physical environment, Good Health and Well Being, Adult, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Humans, Hypoglycemic Agents, Life Style, Metformin, Diabetes Prevention Program Research Group, Diabetes Prevention Program Research Group:, Medical and Health Sciences, Endocrinology & Metabolism, Biomedical and clinical sciences, Health sciences
Abstract

ObjectiveTo determine whether metformin or lifestyle modification can lower rates of all-cause and cause-specific mortality in the Diabetes Prevention Program and Diabetes Prevention Program Outcomes Study.Research design and methodsFrom 1996 to 1999, 3,234 adults at high risk for type 2 diabetes were randomized to an intensive lifestyle intervention, masked metformin, or placebo. Placebo and lifestyle interventions stopped in 2001, and a modified lifestyle program was offered to everyone, but unmasked study metformin continued in those originally randomized. Causes of deaths through 31 December 2018 were adjudicated by blinded reviews. All-cause and cause-specific mortality hazard ratios (HRs) were estimated from Cox proportional hazards regression models and Fine-Gray models, respectively.ResultsOver a median of 21 years (interquartile range 20-21), 453 participants died. Cancer was the leading cause of death (n = 170), followed by cardiovascular disease (n = 131). Compared with placebo, metformin did not influence mortality from all causes (HR 0.99 [95% CI 0.79, 1.25]), cancer (HR 1.04 [95% CI 0.72, 1.52]), or cardiovascular disease (HR 1.08 [95% CI 0.70, 1.66]). Similarly, lifestyle modification did not impact all-cause (HR 1.02 [95% CI 0.81, 1.28]), cancer (HR 1.07 [95% CI 0.74, 1.55]), or cardiovascular disease (HR 1.18 [95% CI 0.77, 1.81]) mortality. Analyses adjusted for diabetes status and duration, BMI, cumulative glycemic exposure, and cardiovascular risks yielded results similar to those for all-cause mortality.ConclusionsCancer was the leading cause of mortality among adults at high risk for type 2 diabetes. Although metformin and lifestyle modification prevented diabetes, neither strategy reduced all-cause, cancer, or cardiovascular mortality rates.

Published
2021

2. Erratum: 'Prenatal Exposure to per- and Polyfluoroalkyl Substances, Umbilical Cord Blood DNA Methylation, and Cardio-Metabolic Indicators in Newborns: The Healthy Start Study'

Author

Starling, Anne P., Liu, Cuining, Shen, Guannan, Yang, Ivana V., Kechris, Katerina, Borengasser, Sarah J., Boyle, Kristen E., Zhang, Weiming, Smith, Harry A., Calafat, Antonia M., Hamman, Richard F., Adgate, John L., and Dabelea, Dana

Subjects
DNA -- Research, Genetic research, Methylation -- Research, Pregnant women -- Research, Infants (Newborn) -- Research, Environmental issues, Health
Abstract

The published article contained errors in the descriptive reporting of the number of per- and polyfluoroalkyl substances (PFAS) concentrations that were below the method limit of detection (LOD; 0.1 ng/mL) [...]

Published
2023
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3. Circulating sex hormone binding globulin levels are modified with intensive lifestyle intervention, but their changes did not independently predict diabetes risk in the Diabetes Prevention Program

Author

Aroda, Vanita R, Christophi, Costas A, Edelstein, Sharon L, Perreault, Leigh, Kim, Catherine, Golden, Sherita H, Horton, Edward, Mather, Kieren J, Bray, George A, Gadde, Kishore, Culbert, Iris W, Arceneaux, Jennifer, Chatellier, Annie, Dragg, Amber, Champagne, Catherine M, Duncan, Crystal, Eberhardt, Barbara, Greenway, Frank, Guillory, Fonda G, Herbert, April A, Jeffirs, Michael L, Kennedy, Betty M, Levy, Erma, Lockett, Monica, Lovejoy, Jennifer C, Morris, Laura H, Melancon, Lee E, Ryan, Donna H, Sanford, Deborah A, Smith, Kenneth G, Smith, Lisa L, St, Julia A, Amant, Richard T Tulley, Vicknair, Paula C, Williamson, Donald, Zachwieja, Jeffery J, Polonsky, Kenneth S, Tobian, Janet, Ehrmann, David A, Matulik, Margaret J, Clark, Bart, Czech, Kirsten, DeSandre, Catherine, Hilbrich, Ruthanne, McNabb, Wylie, Semenske, Ann R, Caro, Jose F, Furlong, Kevin, Goldstein, Barry J, Watson, Pamela G, Smith, Kellie A, Mendoza, Jewel, Wildman, Wendi, Liberoni, Renee, Spandorfer, John, Pepe, Constance, Donahue, Richard P, Goldberg, Ronald B, Prineas, Ronald, Calles, Jeanette, Ojito, Juliet, Rowe, Patricia, Cassanova-Romero, Paul, Castillo-Florez, Sumaya, Florez, Hermes J, Giannella, Anna, Kirby, Lascelles, Larreal, Carmen, Lara, Olga, McLymont, Valerie, Mendez, Jadell, Perry, Arlette, Saab, Patrice, Veciana, Beth, Haffner, Steven M, Hazuda, Helen P, Montez, Maria G, Hattaway, Kathy, Lorenzo, Carlos, Martinez, Arlene, Walker, Tatiana, Dabelea, Dana, Hamman, Richard F, Nash, Patricia V, Steinke, Sheila C, Testaverde, Lisa, Anderson, Denise R, Ballonoff, Larry B, Bouffard, Alexis, Bucca, Brian, Calonge, B Ned, Delve, Lynne, Farago, Martha, Hill, James O, Hoyer, Shelley R, Jenkins, Tonya, Jortberg, Bonnie T, Lenz, Dione, and Miller, Marsha

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Diabetes, Cardiovascular, Obesity, Estrogen, Clinical Research, Prevention, Nutrition, Aging, Clinical Trials and Supportive Activities, 3.1 Primary prevention interventions to modify behaviours or promote wellbeing, Prevention of disease and conditions, and promotion of well-being, Metabolic and endocrine, Diabetes Mellitus, Type 2, Female, Glucose Intolerance, Humans, Life Style, Male, Metformin, Sex Hormone-Binding Globulin, DPP Research Group, diabetes mellitus, hormone, life style, primary prevention, type 2, Clinical sciences, Public health
Abstract

Sex hormone binding globulin (SHBG) levels are reported to be inversely associated with diabetes risk. It is unknown whether diabetes prevention interventions increase SHBG and whether resultant changes in SHBG affect diabetes risk. The purpose of this analysis was to determine whether intensive lifestyle intervention (ILS) or metformin changed circulating SHBG and if resultant changes influenced diabetes risk in the Diabetes Prevention Program (DPP). This is a secondary analysis from the DPP (1996-2001), a randomized trial of ILS or metformin versus placebo on diabetes risk over a mean follow-up of 3.2 years. The DPP was conducted across 27 academic study centers in the USA. Men, premenopausal and postmenopausal women without hormone use in the DPP were evaluated. The DPP included overweight/obese persons with elevated fasting glucose and impaired glucose tolerance. Main outcomes measures were changes in SHBG levels at 1 year and risk of diabetes over 3 years. ILS resulted in significantly higher increases (postmenopausal women: p

Published
2020

4. Interaction Between Type 2 Diabetes Prevention Strategies and Genetic Determinants of Coronary Artery Disease on Cardiometabolic Risk Factors

Author

Merino, Jordi, Jablonski, Kathleen A, Mercader, Josep M, Kahn, Steven E, Chen, Ling, Harden, Maegan, Delahanty, Linda M, Araneta, Maria Rosario G, Walford, Geoffrey A, Jacobs, Suzanne BR, Ibebuogu, Uzoma N, Franks, Paul W, Knowler, William C, Florez, Jose C, Bray, George A, Gadde, Kishore, Chatellier, Annie, Arceneaux, Jennifer, Dragg, Amber, Duncan, Crystal, Greenway, Frank L, Hsia, Daniel, Levy, Erma, Lockett, Monica, Ryan, Donna H, Ehrmann, David, Matulik, Margaret J, Czech, Kirsten, DeSandre, Catherine, Goldstein, Barry J, Furlong, Kevin, Smith, Kellie A, Wildman, Wendi, Pepe, Constance, Goldberg, Ronald B, Calles, Jeanette, Ojito, Juliet, Castillo-Florez, Sumaya, Florez, Hermes J, Giannella, Anna, Lara, Olga, Veciana, Beth, Haffner, Steven M, Hazuda, Helen P, Montez, Maria G, Hattaway, Kathy, Lorenzo, Carlos, Martinez, Arlene, Walker, Tatiana, Hamman, Richard F, Dabelea, Dana, Testaverde, Lisa, Anderson, Denise, Bouffard, Alexis, Jenkins, Tonya, Lenz, Dione, Perreault, Leigh, Price, David W, Steinke, Sheila C, Horton, Edward S, Poirier, Catherine S, Swift, Kati, Caballero, Enrique, Fargnoli, Barbara, Guidi, Ashley, Guido, Mathew, Jackson, Sharon D, Lambert, Lori, Lawton, Kathleen E, Ledbury, Sarah, Sansoucy, Jessica, Spellman, Jeanne, Montgomery, Brenda K, Fujimoto, Wilfred, Knopp, Robert H, Lipkin, Edward W, Morgan-Taggart, Ivy, Murillo, Anne, Taylor, Lonnese, Thomas, April, Tsai, Elaine C, Trence, Dace, Kitabchi, Abbas E, Dagogo-Jack, Samuel, Murphy, Mary E, Taylor, Laura, Dolgoff, Jennifer, Clark, Debra, Ibebuogu, Uzoma, Lambeth, Helen, Ricks, Harriet, Rutledge, Lily MK, Soberman, Judith E, Molitch, Mark E, Metzger, Boyd E, Johnson, Mariana K, Giles, Mimi M, Larsen, Diane, and Pen, Samsam C

Subjects
Biomedical and Clinical Sciences, Diabetes, Clinical Research, Atherosclerosis, Clinical Trials and Supportive Activities, Cardiovascular, Heart Disease, Prevention, Heart Disease - Coronary Heart Disease, Nutrition, Obesity, Metabolic and endocrine, Good Health and Well Being, Adult, Cardiovascular Diseases, Coronary Artery Disease, Diabetes Mellitus, Type 2, Exercise, Exercise Therapy, Female, Gene-Environment Interaction, Genetic Predisposition to Disease, Humans, Life Style, Male, Metabolic Syndrome, Metformin, Middle Aged, Prediabetic State, Preventive Health Services, Risk Factors, United States, Diabetes Prevention Program Research Group, Medical and Health Sciences, Endocrinology & Metabolism, Biomedical and clinical sciences
Abstract

Coronary artery disease (CAD) is more frequent among individuals with dysglycemia. Preventive interventions for diabetes can improve cardiometabolic risk factors (CRFs), but it is unclear whether the benefits on CRFs are similar for individuals at different genetic risk for CAD. We built a 201-variant polygenic risk score (PRS) for CAD and tested for interaction with diabetes prevention strategies on 1-year changes in CRFs in 2,658 Diabetes Prevention Program (DPP) participants. We also examined whether separate lifestyle behaviors interact with PRS and affect changes in CRFs in each intervention group. Participants in both the lifestyle and metformin interventions had greater improvement in the majority of recognized CRFs compared with placebo (P < 0.001) irrespective of CAD genetic risk (P interaction > 0.05). We detected nominal significant interactions between PRS and dietary quality and physical activity on 1-year change in BMI, fasting glucose, triglycerides, and HDL cholesterol in individuals randomized to metformin or placebo, but none of them achieved the multiple-testing correction for significance. This study confirms that diabetes preventive interventions improve CRFs regardless of CAD genetic risk and delivers hypothesis-generating data on the varying benefit of increasing physical activity and improving diet on intermediate cardiovascular risk factors depending on individual CAD genetic risk profile.

Published
2020

7. Evaluating Community-Based Translational Interventions Using Historical Controls: Propensity Score vs. Disease Risk Score Approach

Author

Jiang, Luohua, Chen, Shuai, Beals, Janette, Siddique, Juned, Hamman, Richard F, Bullock, Ann, and Manson, Spero M

Subjects
Epidemiology, Health Services and Systems, Health Sciences, Clinical Research, Clinical Trials and Supportive Activities, Prevention, Comparative Effectiveness Research, American Indian or Alaska Native, Nutrition, Diabetes, Metabolic and endocrine, Adult, Alaskan Natives, Diabetes Mellitus, Type 2, Female, Humans, Indians, North American, Life Style, Male, Middle Aged, Propensity Score, Risk Assessment, Comparative effectiveness evaluation, Disease risk score, Prognostic score, Propensity score, Single-arm intervention, Historical controls, Special Diabetes Program for Indians Diabetes Prevention Demonstration Project, Grant programs participating in the Special Diabetes Program for Indians Diabetes Prevention Program are as follows: Confederated Tribes of the Chehalis Reservation, Cherokee Nation, Cheyenne River Sioux Tribe, the Chickasaw Nation, Coeur d’Alene Tribe, Colorado River Indian Tribes, Colville Confederated Tribes, Cow Creek Band of Umpqua Tribe, Klamath Tribes, and Coquille Tribe, Fond du Lac Reservation, Gila River Health Care, Haskell Health Center, Ho-Chunk Nation, Indian Health Board of Minneapolis, Indian Health Center of Santa Clara Valley, Native American Rehabilitation Association of the NW, Hunter Health, Kenaitze Indian Tribe IRA, Lawton IHS Service Unit, Menominee Indian Tribe of Wisconsin, Mississippi Band of Choctaw Indians, Norton Sound Health Corporation, Pine Ridge IHS Service Unit, Pueblo of San Felipe, Quinault Indian Nation, Rapid City IHS Diabetes Program, Red Lake Comprehensive Health Services, Rocky Boy Health Board, Seneca Nation of Indians, Sonoma County Indian Health Project, South East Alaska Regional Health Consortium, Southcentral Foundation, Trenton Indian Service Area, Tuba City Regional Health Care Corporation, United American Indian Involvement, Inc., United Indian Health Services, Inc., Warm Springs Health & Wellness Center, Winnebago Tribe of Nebraska, Zuni Pueblo., Public Health and Health Services, Substance Abuse, Public health, Clinical and health psychology
Abstract

Many community-based translations of evidence-based interventions are designed as one-arm studies due to ethical and other considerations. Evaluating the impacts of such programs is challenging. Here, we examine the effectiveness of the lifestyle intervention implemented by the Special Diabetes Program for Indians Diabetes Prevention (SDPI-DP) demonstration project, a translational lifestyle intervention among American Indian and Alaska Native communities. Data from the landmark Diabetes Prevention Program placebo group was used as a historical control. We compared the use of propensity score (PS) and disease risk score (DRS) matching to adjust for potential confounder imbalance between groups. The unadjusted hazard ratio (HR) for diabetes risk was 0.35 for SDPI-DP lifestyle intervention vs. control. However, when relevant diabetes risk factors were considered, the adjusted HR estimates were attenuated toward 1, ranging from 0.56 (95% CI 0.44-0.71) to 0.69 (95% CI 0.56-0.96). The differences in estimated HRs using the PS and DRS approaches were relatively small but DRS matching resulted in more participants being matched and smaller standard errors of effect estimates. Carefully employed, publicly available randomized clinical trial data can be used as a historical control to evaluate the intervention effectiveness of one-arm community translational initiatives. It is critical to use a proper statistical method to balance the distributions of potential confounders between comparison groups in this kind of evaluations.

Published
2019

11. Brief Report: Prevalence of Self-Injurious Behaviors among Children with Autism Spectrum Disorder--A Population-Based Study

Author

Soke, Gnakub N., Rosenberg, Steven A., Hamman, Richard F., Fingerlin, Tasha, Robinson, Cordelia, Carpenter, Laura, Giarelli, Ellen, Lee, Li-Ching, Wiggins, Lisa D., Durkin, Maureen S., and DiGuiseppi, Carolyn

Abstract

Self-injurious behaviors (SIB) have been reported in more than 30% of children with an autism spectrum disorder (ASD) in clinic-based studies. This study estimated the prevalence of SIB in a large population-based sample of children with ASD in the United States. A total of 8,065 children who met the surveillance case definition for ASD in the Autism and Developmental Disabilities Monitoring (ADDM) Network during the 2000, 2006, and 2008 surveillance years were included. The presence of SIB was reported from available health and/or educational records by an expert clinician in ADDM Network. SIB prevalence averaged 27.7% across all sites and surveillance years, with some variation between sites. Clinicians should inquire about SIB during assessments of children with ASD.

Published
2016
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12. Genetic Modulation of Lipid Profiles following Lifestyle Modification or Metformin Treatment: The Diabetes Prevention Program

Author

Pollin, Toni I, Isakova, Tamara, Jablonski, Kathleen A, de Bakker, Paul IW, Taylor, Andrew, McAteer, Jarred, Pan, Qing, Horton, Edward S, Delahanty, Linda M, Altshuler, David, Shuldiner, Alan R, Goldberg, Ronald B, Florez, Jose C, Franks, Paul W, Bray, George A, Culbert, Iris W, Champagne, Catherine M, Eberhardt, Barbara, Greenway, Frank, Guillory, Fonda G, Herbert, April A, Jeffirs, Michael L, Kennedy, Betty M, Lovejoy, Jennifer C, Morris, Laura H, Melancon, Lee E, Ryan, Donna, Sanford, Deborah A, Smith, Kenneth G, Smith, Lisa L, St. Amant, Julia A, Tulley, Richard T, Vicknair, Paula C, Williamson, Donald, Zachwieja, Jeffery J, Polonsky, Kenneth S, Tobian, Janet, Ehrmann, David, Matulik, Margaret J, Clark, Bart, Czech, Kirsten, DeSandre, Catherine, Hilbrich, Ruthanne, McNabb, Wylie, Semenske, Ann R, Caro, Jose F, Watson, Pamela G, Goldstein, Barry J, Smith, Kellie A, Mendoza, Jewel, Liberoni, Renee, Pepe, Constance, Spandorfer, John, Donahue, Richard P, Prineas, Ronald, Rowe, Patricia, Calles, Jeanette, Cassanova-Romero, Paul, Florez, Hermes J, Giannella, Anna, Kirby, Lascelles, Larreal, Carmen, McLymont, Valerie, Mendez, Jadell, Ojito, Juliet, Perry, Arlette, Saab, Patrice, Haffner, Steven M, Montez, Maria G, Lorenzo, Carlos, Martinez, Arlene, Hamman, Richard F, Nash, Patricia V, Testaverde, Lisa, Anderson, Denise R, Ballonoff, Larry B, Bouffard, Alexis, Calonge, B Ned, Delve, Lynne, Farago, Martha, Hill, James O, Hoyer, Shelley R, Jortberg, Bonnie T, Lenz, Dione, Miller, Marsha, Price, David W, Regensteiner, Judith G, Seagle, Helen, Smith, Carissa M, Steinke, Sheila C, VanDorsten, Brent, Lawton, Kathleen E, Arky, Ronald A, Bryant, Marybeth, Burke, Jacqueline P, Caballero, Enrique, Callaphan, Karen M, and Ganda, Om P

Subjects
Diabetes, Nutrition, Clinical Research, Prevention, Genetics, Cardiovascular, Metabolic and endocrine, Adult, Cardiovascular Diseases, Cholesterol, HDL, Cholesterol, LDL, Diabetes Mellitus, Type 2, Dyslipidemias, Female, Genetic Association Studies, Humans, Hypoglycemic Agents, Life Style, Lipid Metabolism, Lipoproteins, Magnetic Resonance Spectroscopy, Male, Metformin, Middle Aged, Polymorphism, Single Nucleotide, Risk Factors, Triglycerides, Weight Loss, Diabetes Prevention Program Research Group, Developmental Biology
Abstract

Weight-loss interventions generally improve lipid profiles and reduce cardiovascular disease risk, but effects are variable and may depend on genetic factors. We performed a genetic association analysis of data from 2,993 participants in the Diabetes Prevention Program to test the hypotheses that a genetic risk score (GRS) based on deleterious alleles at 32 lipid-associated single-nucleotide polymorphisms modifies the effects of lifestyle and/or metformin interventions on lipid levels and nuclear magnetic resonance (NMR) lipoprotein subfraction size and number. Twenty-three loci previously associated with fasting LDL-C, HDL-C, or triglycerides replicated (P = 0.04-1 × 10(-17)). Except for total HDL particles (r = -0.03, P = 0.26), all components of the lipid profile correlated with the GRS (partial |r| = 0.07-0.17, P = 5 × 10(-5)-1 10(-19)). The GRS was associated with higher baseline-adjusted 1-year LDL cholesterol levels (β = +0.87, SEE ± 0.22 mg/dl/allele, P = 8 × 10(-5), P(interaction) = 0.02) in the lifestyle intervention group, but not in the placebo (β = +0.20, SEE ± 0.22 mg/dl/allele, P = 0.35) or metformin (β = -0.03, SEE ± 0.22 mg/dl/allele, P = 0.90; P(interaction) = 0.64) groups. Similarly, a higher GRS predicted a greater number of baseline-adjusted small LDL particles at 1 year in the lifestyle intervention arm (β = +0.30, SEE ± 0.012 ln nmol/L/allele, P = 0.01, P(interaction) = 0.01) but not in the placebo (β = -0.002, SEE ± 0.008 ln nmol/L/allele, P = 0.74) or metformin (β = +0.013, SEE ± 0.008 nmol/L/allele, P = 0.12; P(interaction) = 0.24) groups. Our findings suggest that a high genetic burden confers an adverse lipid profile and predicts attenuated response in LDL-C levels and small LDL particle number to dietary and physical activity interventions aimed at weight loss.

Published
2012

16. The Effect of Interventions to Prevent Type 2 Diabetes on the Development of Diabetic Retinopathy: The DPP/DPPOS Experience

Author

White, Neil H., Pan, Qing, Knowler, William C., Schroeder, Emily B., Dabelea, Dana, Chew, Emily Y., Blodi, Barbara, Goldberg, Ronald B., Pi-Sunyer, Xavier, Darwin, Christine, Schlögl, Mathias, Nathan, David M., Goldstein, Barry J., Furlong, Kevin, Smith, Kellie A., Mendoza, Jewel, Wildman, Wendi, Simmons, Marsha, Jensen, Genine, Liberoni, Renee, Spandorfer, John, Pepe, Constance, Donahue, Richard P., Prineas, Ronald, Rowe, Patricia, Giannella, Anna, Calles, Jeanette, Sanguily, Juliet, Cassanova-Romero, Paul, Castillo-Florez, Sumaya, Florez, Hermes J., Garg, Rajesh, Kirby, Lascelles, Lara, Olga, Larreal, Carmen, McLymont, Valerie, Mendez, Jadell, Perry, Arlette, Saab, Patrice, Veciana, Bertha, Haffner, Steven M., Hazuda, Helen P., Montez, Maria G., Isaac, Juan, Hattaway, Kathy, Lorenzo, Carlos, Martinez, Arlene, Salazar, Monica, Walker, Tatiana, Hamman, Richard F., Nash, Patricia V., Steinke, Sheila C., Testaverde, Lisa, Truong, Jennifer, Anderson, Denise R., Ballonoff, Larry B., Bouffard, Alexis, Boxer, Rebecca S., Bucca, Brian, Calonge, B. Ned, Delve, Lynne, Farago, Martha, Hill, James O., Hoyer, Shelley R., Jenkins, Tonya, Jortberg, Bonnie T., Lenz, Dione, Miller, Marsha, Nilan, Thomas, Perreault, Leigh, Price, David W., Regensteiner, Judith G., Seagle, Helen, Smith, Carissa M., VanDorsten, Brent, Horton, Edward S., Munshi, Medha, Lawton, Kathleen E., Poirier, Catherine S., Swift, Kati, Jackson, Sharon D., Arky, Ronald A., Bryant, Marybeth, Burke, Jacqueline P., Caballero, Enrique, Callaphan, Karen M., Fargnoli, Barbara, Franklin, Therese, Ganda, Om P., Guidi, Ashley, Guido, Mathew, Jacobsen, Alan M., Kula, Lyn M., Kocal, Margaret, Lambert, Lori, Ledbury, Sarah, Malloy, Maureen A., Middelbeek, Roeland J.W., Nicosia, Maryanne, Oldmixon, Cathryn F., Pan, Jocelyn, Quitingon, Marizel, Rainville, Riley, Rubtchinsky, Stacy, Seely, Ellen W., Sansoucy, Jessica, Schweizer, Dana, Simonson, Donald, Smith, Fannie, Solomon, Caren G., Spellman, Jeanne, Warram, James, Kahn, Steven E., Montgomery, Brenda K., Fattaleh, Basma, Colegrove, Celeste, Fujimoto, Wilfred, Knopp, Robert H., Lipkin, Edward W., Marr, Michelle, Morgan-Taggart, Ivy, Murillo, Anne, O’Neal, Kayla, Trence, Dace, Taylor, Lonnese, Thomas, April, Tsai, Elaine C., Kitabchi, Abbas E., Dagogo-Jack, Samuel, Murphy, Mary E., Taylor, Laura, Dolgoff, Jennifer, Hampton, Ethel Faye, Applegate, William B., Bryer-Ash, Michael, Clark, Debra, Frieson, Sandra L., Ibebuogu, Uzoma, Imseis, Raed, Lambeth, Helen, Lichtermann, Lynne C., Oktaei, Hooman, Ricks, Harriet, Rutledge, Lily M.K., Sherman, Amy R., Smith, Clara M., Soberman, Judith E., Williamsleaves, Beverly, Patel, Avnisha, Nyenwe, Ebenezer A., Metzger, Boyd E., Molitch, Mark E., Wallia, Amisha, Johnson, Mariana K., VanderMolen, Sarah, Adelman, Daphne T., Behrends, Catherine, Cook, Michelle, Fitzgibbon, Marian, Giles, Mimi M., Hartmuller, Monica, Johnson, Cheryl K.H., Larsen, Diane, Lowe, Anne, Lyman, Megan, McPherson, David, Penn, Samsam C., Pitts, Thomas, Reinhart, Renee, Roston, Susan, Schinleber, Pamela A., McKitrick, Charles, Turgeon, Heather, Larkin, Mary, Mugford, Marielle, Thangthaeng, Nopporn, Leander, Fernelle, Abbott, Kathy, Anderson, Ellen, Bissett, Laurie, Bondi, Kristy, Cagliero, Enrico, Florez, Jose C., Delahanty, Linda, Goldman, Valerie, Grassa, Elaine, Gurry, Lindsey, D’Anna, Kali, Leandre, Fernelle, Lou, Peter, Poulos, Alexandra, Raymond, Elyse, Ripley, Valerie, Stevens, Christine, Tseng, Beverly, Olefsky, Jerrold M., Barrettonnor, Elizabeth, Mudaliar, Sunder, Rosario Araneta, Maria, Carrion-Petersen, Mary Lou, Vejvoda, Karen, Bassiouni, Sarah, Beltran, Madeline, Claravall, Lauren N., Dowden, Jonalle M., Edelman, Steven V., Garimella, Pranav, Henry, Robert R., Horne, Javiva, Lamkin, Marycie, Szerdi Janesch, Simona, Leos, Diana, Polonsky, William, Ruiz, Rosa, Smith, Jean, Torio-Hurley, Jennifer, Pi-Sunyer, F. Xavier, Laferrere, Blandine, Lee, Jane E., Hagamen, Susan, Kelly-Dinham, Kim, Allison, David B., Agharanya, Nnenna, Aronoff, Nancy J., Baldo, Maria, Crandall, Jill P., Foo, Sandra T., Luchsinger, Jose A., Pal, Carmen, Parkes, Kathy, Pena, Mary Beth, Roman, Julie, Rooney, Ellen S., VanWye, Gretchen E.H., Viscovich, Kristine A., Prince, Melvin J., Marrero, David G., Mather, Kieren J., De Groot, Mary, Kelly, Susie M., Jackson, Marcia A., McAtee, Gina, Putenney, Paula, Ackermann, Ronald T., Cantrell, Carolyn M., Dotson, Yolanda F., Fineberg, Edwin S., Fultz, Megan, Guare, John C., Hadden, Angela, Ignaut, James M., Kirkman, Marion S., O’Kelly Phillips, Erin, Pinner, Kisha L., Porter, Beverly D., Roach, Paris J., Rowland, Nancy D., Wheeler, Madelyn L., Ratner, Robert E., Aroda, Vanita, Magee, Michelle, Youssef, Gretchen, Shapiro, Sue, Andon, Natalie, Bavido-Arrage, Catherine, Boggs, Geraldine, Bronsord, Marjorie, Brown, Ernestine, Love Burkott, Holly, Cheatham, Wayman W., Cola, Susan, Evans, Cindy, Gibbs, Peggy, Kellum, Tracy, Leon, Lilia, Lagarda, Milvia, Levatan, Claresa, Lindsay, Milajurine, Nair, Asha K., Park, Jean, Passaro, Maureen, Silverman, Angela, Uwaifo, Gabriel, Wells-Thayer, Debra, Wiggins, Renee, Saad, Mohammed F., Watson, Karol, Budget, Maria, Jinagouda, Sujata, Botrous, Medhat, Sosa, Anthony, Tadros, Sameh, Akbar, Khan, Conzues, Claudia, Magpuri, Perpetua, Ngo, Kathy, Rassam, Amer, Waters, Debra, Xapthalamous, Kathy, Santiago, Julio V., Brown, Angela L., Santiago, Ana, Das, Samia, Khare-Ranade, Prajakta, Stich, Tamara, Fisher, Edwin, Hurt, Emma, Jones, Jackie, Jones, Tracy, Kerr, Michelle, McCowan, Sherri, Ryder, Lucy, Wernimont, Cormarie, Saudek, Christopher D., Hill Golden, Sherita, Bradley, Vanessa, Sullivan, Emily, Whittington, Tracy, Abbas, Caroline, Allen, Adrienne, Brancati, Frederick L., Cappelli, Sharon, Clark, Jeanne M., Charleston, Jeanne B., Freel, Janice, Horak, Katherine, Greene, Alicia, Jiggetts, Dawn, Johnson, Delois, Joseph, Hope, Kalyani, Rita, Loman, Kimberly, Mathioudakis, Nestoras, Maruthur, Nisa, Mosley, Henry, Reusing, John, Rubin, Richard R., Samuels, Alafia, Shields, Thomas, Stephens, Shawne, Stewart, Kerry J., Thomas, LeeLana, Utsey, Evonne, Williamson, Paula, Schade, David S., Adams, Karwyn S., Johannes, Carolyn, Hemphill, Claire, Hyde, Penny, Canady, Janene L., Atler, Leslie F., Boyle, Patrick J., Burge, Mark R., Chai, Lisa, Colleran, Kathleen, Fondino, Ateka, Gonzales, Ysela, Hernandez-McGinnis, Doris A., Katz, Patricia, King, Carolyn, Middendorf, Julia, Rubinchik, Sofya, Senter, Willette, Shamoon, Harry, Crandall, Jill, Brown, Janet O., Trandafirescu, Gilda, Powell, Danielle, Adorno, Elsie, Cox, Liane, Duffy, Helena, Engel, Samuel, Friedler, Allison, Goldstein, Angela, Howardentury, Crystal J., Lukin, Jennifer, Kloiber, Stacey, Longchamp, Nadege, Martinez, Helen, Pompi, Dorothy, Scheindlin, Jonathan, Tomuta, Norica, Violino, Elissa, Walker, Elizabeth A., Wylie-Rosett, Judith, Zimmerman, Elise, Zonszein, Joel, Wing, Rena R., Orchard, Trevor, Venditti, Elizabeth, Koenning, Gaye, Kramer, M. Kaye, Smith, Marie, Jeffries, Susan, Weinzierl, Valarie, Barr, Susan, Benchoff, Catherine, Boraz, Miriam, Clifford, Lisa, Culyba, Rebecca, Frazier, Marlene, Gilligan, Ryan, Guimond, Stephanie, Harrier, Susan, Harris, Louann, Kriska, Andrea, Manjoo, Qurashia, Mullen, Monica, Noel, Alicia, Otto, Amy, Pettigrew, Jessica, Rockette-Wagner, Bonny, Rubinstein, Debra, Semler, Linda, Smith, Cheryl F., Williams, Katherine V., Wilson, Tara, Arakaki, Richard F., Mau, Marjorie K., Latimer, Renee W., Isonaga, Mae K., Baker-Ladao, Narleen K., Bow, Ralph, Bermudez, Nina E., Dias, Lorna, Inouye, Jillian, Melish, John S., Mikami, Kathy, Mohideen, Pharis, Odom, Sharon K., Perry, Raynette U., Yamamoto, Robin E., Hanson, Robert L., Shah, Vallabh, Hoskin, Mary A., Percy, Carol A., Cooeyate, Norman, Natewa, Camille, Dodge, Charlotte, Enote, Alvera, Anderson, Harelda, Acton, Kelly J., Andre, Vickie L., Barber, Rosalyn, Begay, Shandiin, Bennett, Peter H., Benson, Mary Beth, Bird, Evelyn C., Broussard, Brenda A., Bucca, Brian C., Chavez, Marcella, Cook, Sherron, Curtis, Jeff, Dacawyma, Tara, Doughty, Matthew S., Duncan, Roberta, Edgerton, Cyndy, Ghahate, Jacqueline M., Glass, Justin, Glass, Martia, Gohdes, Dorothy, Grant, Wendy, Horse, Ellie, Ingraham, Louise E., Jackson, Merry, Jay, Priscilla, Kaskalla, Roylen S., Kavena, Karen, Kessler, David, Kobus, Kathleen M., Krakoff, Jonathan, Kurland, Jason, Manus, Catherine, McCabe, Cherie, Michaels, Sara, Morgan, Tina, Nashboo, Yolanda, Nelson, Julie A., Poirier, Steven, Polczynski, Evette, Piromalli, Christopher, Reidy, Mike, Roumain, Jeanine, Rowse, Debra, Roy, Robert J., Sangster, Sandra, Sewenemewa, Janet, Smart, Miranda, Spencer, Chelsea, Tonemah, Darryl, Williams, Rachel, Wilson, Charlton, Yazzie, Michelle, Bain, Raymond, Fowler, Sarah, Larsen, Michael D., Jablonski, Kathleen, Temprosa, Marinella, Brenneman, Tina, Edelstein, Sharon L., Abebe, Solome, Bamdad, Julie, Barkalow, Melanie, Bethepu, Joel, Bezabeh, Tsedenia, Bowers, Anna, Butler, Nicole, Callaghan, Jackie, Carter, Caitlin E., Christophi, Costas, Dwyer, Gregory M., Foulkes, Mary, Gao, Yuping, Gooding, Robert, Gottlieb, Adrienne, Grimes, Kristina L., Grover-Fairchild, Nisha, Haffner, Lori, Hoffman, Heather, Jones, Steve, Jones, Tara L., Katz, Richard, Kolinjivadi, Preethy, Lachin, John M., Ma, Yong, Mucik, Pamela, Orlosky, Robert, Reamer, Susan, Rochon, James, Sapozhnikova, Alla, Sherif, Hanna, Stimpson, Charlotte, Hogan Tjaden, Ashley, Walker-Murray, Fredricka, Venditti, Elizabeth M., Kriska, Andrea M., Weinzierl, Valerie, Marcovina, Santica, Aldrich, F. Alan, Harting, Jessica, Albers, John, Strylewicz, Greg, Killeen, Anthony, Gabrielson, Deanna, Eastman, R., Fradkin, Judith, Garfield, Sanford, Lee, Christine, Gregg, Edward, Zhang, Ping, O’Leary, Dan, Evans, Gregory, Budoff, Matthew, Dailing, Chris, Stamm, Elizabeth, Schwartz, Ann, Navy, Caroline, Palermo, Lisa, Rautaharju, Pentti, Prineas, Ronald J., Soliman, Elsayed Z., Alexander, Teresa, Campbell, Charles, Hall, Sharon, Li, Yabing, Mills, Margaret, Pemberton, Nancy, Rautaharju, Farida, Zhang, Zhuming, Hu, Julie, Hensley, Susan, Keasler, Lisa, Taylor, Tonya, Danis, Ronald, Davis, Matthew, Hubbard, Larry, Endres, Ryan, Elsas, Deborah, Johnson, Samantha, Myers, Dawn, Barrett, Nancy, Baumhauer, Heather, Benz, Wendy, Cohn, Holly, Corkery, Ellie, Dohm, Kristi, Domalpally, Amitha, Gama, Vonnie, Goulding, Anne, Ewen, Andy, Hurtenbach, Cynthia, Lawrence, Daniel, McDaniel, Kyle, Pak, Jeong, Reimers, James, Shaw, Ruth, Swift, Maria, Vargo, Pamela, Watson, Sheila, Manly, Jennifer, Mayer-Davis, Elizabeth, Moran, Robert R., Ganiats, Ted, David, Kristin, Sarkin, Andrew J., Groessl, Erik, Katzir, Naomi, Chong, Helen, Herman, William H., Brändle, Michael, Brown, Morton B., Altshuler, David, Billings, Liana K., Chen, Ling, Harden, Maegan, Pollin, Toni I., Shuldiner, Alan R., Franks, Paul W., and Hivert, Marie-France

Subjects
Advanced and Specialized Nursing, Endocrinology, Diabetes and Metabolism, Internal Medicine, Pathophysiology/Complications
Abstract

OBJECTIVE To determine whether interventions that slow or prevent the development of type 2 diabetes in those at risk reduce the subsequent prevalence of diabetic retinopathy. RESEARCH DESIGN AND METHODS The Diabetes Prevention Program (DPP) randomized subjects at risk for developing type 2 diabetes because of overweight/obesity and dysglycemia to metformin (MET), intensive lifestyle intervention (ILS), or placebo (PLB) to assess the prevention of diabetes. During the DPP and DPP Outcome Study (DPPOS), we performed fundus photography over time on study participants, regardless of their diabetes status. Fundus photographs were graded using the Early Treatment Diabetic Retinopathy Study grading system, with diabetic retinopathy defined as typical lesions of diabetic retinopathy (microaneurysms, exudates, or hemorrhage, or worse) in either eye. RESULTS Despite reduced progression to diabetes in the ILS and MET groups compared with PLB, there was no difference in the prevalence of diabetic retinopathy between treatment groups after 1, 5, 11, or 16 years of follow-up. No treatment group differences in retinopathy were found within prespecified subgroups (baseline age, sex, race/ethnicity, baseline BMI). In addition, there was no difference in the prevalence of diabetic retinopathy between those exposed to metformin and those not exposed to metformin, regardless of treatment group assignment. CONCLUSIONS Interventions that delay or prevent the onset of type 2 diabetes in overweight/obese subjects with dysglycemia who are at risk for diabetes do not reduce the development of diabetic retinopathy for up to 20 years.

Published
2022

22. Association of Type 1 Diabetes vs Type 2 Diabetes Diagnosed During Childhood and Adolescence With Complications During Teenage Years and Young Adulthood

Author

Dabelea, Dana, Stafford, Jeanette M., Mayer-Davis, Elizabeth J., D’Agostino, Ralph, Jr, Dolan, Lawrence, Imperatore, Giuseppina, Linder, Barbara, Lawrence, Jean M., Marcovina, Santica M., Mottl, Amy K., Black, Mary Helen, Pop-Busui, Rodica, Saydah, Sharon, Hamman, Richard F., and Pihoker, Catherine

Published
2017
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26. Impairment of executive cognitive control in type 2 diabetes, and its effects on health-related behavior and use of health services

Author

Tran, Dinh, Baxter, Judith, Hamman, Richard F., and Grigsby, Jim

Subjects
Patient compliance -- Research, Type 2 diabetes -- Research -- Care and treatment -- Patient outcomes -- Economic aspects -- Risk factors -- Complications and side effects, Cognition disorders -- Research -- Risk factors, Psychology and mental health
Abstract

We evaluated whether, among persons with type 2 diabetes: (1) impaired executive cognitive functioning (ECF) is more common than among people without diabetes; (2) ECF is associated with the capacity to engage in instrumental health-related behaviors; and (3) worse ECF is associated with increased health services utilization. A population-based sample of 1, 063 older people was interviewed regarding medical history and health services utilization; participants were administered the Mini Mental State Exam and the Behavioral Dyscontrol Scale, a measure of ECF. Participants with diabetes performed more poorly on cognitive measures than those without diabetes. Among those with diabetes, lower ECF was associated with more outpatient care and with ever having been in a nursing home. Impaired behavioral self-regulation may affect the capacity to engage in behaviors that could improve clinical status, resulting in greater health services use. The findings suggest the possibility of a positive feedback loop, with ECF deficits adversely affecting adherence, in turn leading to greater cognitive impairment--an issue for future research. Keywords Diabetes mellitus * Complications of diabetes mellitus * Cognition disorders * Executive functioning * Health behavior * Health services use * Patient compliance * Behavioral dyscontrol scale * San Luis Valley Health and Aging Study (SLVHAS), Introduction Type 2 diabetes mellitus (DM) is associated with impaired cognition (McGuire, Ford, & Ajani, 2006; Sinclair, Girling, & Bayer, 2000). When DM is untreated or inadequately managed, there may [...]

Published
2014
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36. Use of administrative and electronic health record data for development of automated algorithms for childhood diabetes case ascertainment and type classification: the SEARCH for Diabetes in Youth Study†

Author

Zhong, Victor W., Pfaff, Emily R., Beavers, Daniel P., Thomas, Joan, Jaacks, Lindsay M., Bowlby, Deborah A., Carey, Timothy S., Lawrence, Jean M., Dabelea, Dana, Hamman, Richard F., Pihoker, Catherine, Saydah, Sharon H., and Mayer-Davis, Elizabeth J.

Published
2014
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41. Prevalence of diabetes in U.S. youth in 2009: the SEARCH for diabetes in youth study

Author

Pettitt, David J., Talton, Jennifer, Dabelea, Dana, Divers, Jasmin, Imperatore, Giuseppina, Lawrence, Jean M., Liese, Angela D., Linder, Barbara, Mayer-Davis, Elizabeth J., Pihoker, Catherine, Saydah, Sharon H., Standiford, Debra A., and Hamman, Richard F.

Subjects
Health maintenance organizations, Diabetes -- Research, Prevalence studies (Epidemiology), Teenagers, Youth, Native Americans, Health, Kaiser Permanente
Abstract

OBJECTIVE To estimate the prevalence of diabetes in U.S. youth aged RESEARCH DESIGN AND METHODS To address one of its primary aims, the SEARCH for Diabetes in Youth Study identified [...]

Published
2014
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46. Cardiovascular risk factors are associated with increased arterial stiffness in youth with type 1 diabetes: the SEARCH CVD study

Author

Dabelea, Dana, Talton, Jennifer W., D'agostino, Jr., Ralph, Wadwa, R. Paul, Urbina, Elaine M., Dolan, Lawrence M., Daniels, Stephen R., Marcovina, Santica M., and Hamman, Richard F.

Subjects
Blood cholesterol, Type 1 diabetes -- Risk factors -- Research, Trans fatty acids, Teenagers, Youth, Cardiovascular diseases -- Risk factors -- Research, Low density lipoproteins, Health
Abstract

OBJECTIVE--To evaluate if presence of cardiovascular (CV) risk factors and their clustering as metabolic syndrome (MetS) is associated with increased arterial stiffness and accelerated progression over time among youth with [...]

Published
2013
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47. Twenty years of pediatric diabetes surveillance: what do we know and why it matters

Author

Dabelea, Dana, primary, Sauder, Katherine A., additional, Jensen, Elizabeth T., additional, Mottl, Amy K., additional, Huang, Alyssa, additional, Pihoker, Catherine, additional, Hamman, Richard F., additional, Lawrence, Jean, additional, Dolan, Lawrence M., additional, Agostino, Ralph D’, additional, Wagenknecht, Lynne, additional, Mayer‐Davis, Elizabeth J., additional, and Marcovina, Santica M., additional

Published
2021
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49. Diabetic ketoacidosis (DKA) at diagnosis among youth with type 1 and type 2 diabetes: results from SEARCH (US) and YDR (India) registries

Author

Praveen, Pradeep A, Hockett, Christine W, Ong, Toan C, Anandakumar, Amutha, Isom, Scott P, Jensen, Elizabeth T, Mohan, Viswanathan, Dabelea, Dana A, D'Agostino, Ralph B, Hamman, Richard F, Mayer-Davis, Elizabeth J, Lawrence, Jean M, Dolan, Lawrence M., Kahn, Michael G, Madhu, SV, and Tandon, Nikhil

Subjects
Male, endocrine system, endocrine system diseases, Adolescent, Infant, Newborn, nutritional and metabolic diseases, India, Infant, Article, United States, Diabetic Ketoacidosis, Young Adult, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Child, Preschool, Humans, Female, Registries, Child
Abstract

There is significant global variation in the prevalence of diabetic ketoacidosis (DKA) at diagnosis among youth with type 1 diabetes (T1D). However, data for youth with type 2 diabetes (T2D) are limited, even in developed countries. We compared the prevalence of DKA at diagnosis among individuals with T1D and T2D from the SEARCH for Diabetes in Youth (SEARCH) and the Registry of Youth Onset Diabetes in India (YDR) registries.We harmonized the SEARCH and YDR registries to the structure and terminology in the Observational Medical Outcome Partnership Common Data Model. Data used were from youth with T1D and T2D diagnosed before 20 years and newly diagnosed between 2006 and 2012 in YDR and 2009 and 2012 in SEARCH.There were 5366 US youth (4078 with T1D, 1288 with T2D) and 2335 Indian youth (2108 with T1D, 227 with T2D). More than one third of T1D youth enrolled in SEARCH had DKA at diagnosis which was significantly higher than in YDR (35.3% vs 28.7%, P .0001). The burden of DKA in youth with T1D was significantly higher among younger age groups; this relationship was similar across registries (P = .4). The prevalence of DKA among T2D in SEARCH and YDR were 5.5% and 6.6% respectively (P = .4).There is significant burden of DKA at diagnosis with T1D among youth from United States and India, especially among the younger age groups. The reasons for this high prevalence are largely unknown but are critical to developing interventions to prevent DKA at diagnosis.

Published
2020

50. Adapting and implementing a long-term nutrition and physical activity curriculum to a rural, low-income, biethnic community

Author

Belansky, Elaine S., Romaniello, Catherine, Morin, Catherine, Uyeki, Terry, Sawyer, Rebecca L., Scarbro, Sharon, Auld, Garry W., Crane, Lori, Reynolds, Kim, Hamman, Richard F., and Marshall, Julie A.

Subjects
Health education -- Analysis, Nutrition counseling -- Methods, Nutrition counseling -- Analysis, Rural children -- Food and nutrition, Rural children -- Health aspects, Rural children -- Education, Chemistry, Education, Food/cooking/nutrition, Health, Science and technology
Abstract

This study adapted an urban-based school nutrition program for delivery in a rural community. Specific aims were to adapt the curriculum; expand it to include physical activity; determine effectiveness on students' attitudes, knowledge, and self-efficacy; and assess teachers' impressions. Three cohorts were established: 173 students taught by a resource teacher, 170 students taught by classroom teachers, and 187 students who did not receive the curriculum. Pre- and posttest surveys measured outcomes, and classroom teachers were observed and interviewed. The curriculum was shown to be effective in enhancing student outcomes for both the resource teacher and classroom teacher cohorts. Teachers reported that lessons needed to be simplified and that children enjoyed them. Findings support the transferability of an urban-based nutrition curriculum to a rural community and the need for students to receive health education annually.

Published
2006

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