Research Description
The current pandemic has highlighted the urgent need to provide obesity and Type 2 diabetes prevention and treatment programs to children and adolescents via telehealth. However, little is known from past studies about how to shift evidence-based in-person programs to virtual platforms effectively. The Bright Bodies program is a family-based, high-intensity lifestyle modification program tailored to racially/ethnically diverse youth. Two large randomized clinical trials have previously shown that Bright Bodies is an effective program for children with obesity and impaired glucose tolerance. Since April 2020, children and families enrolled in Bright Bodies have participated in web-based activities including nutrition and physical activity classes online. Given its track record of success, Bright Bodies is an ideal program for rigorous study of adaptation for telehealth. This proposal seeks to accelerate understanding of how to provide effective high-intensity virtual interventions for Type 2 diabetes prevention in youth. Program data from pandemic (2020-2021) and pilot (2022) virtual Bright Bodies sessions will be evaluated, and surveys/interviews will be conducted of participants about their experience with the program. In response to feedback from program participants, modifications will be made to optimize the virtual program components. Finally, new participants with prediabetes ages 10-17 will then be enrolled in a 6-month pilot study to evaluate the feasibility, acceptability, and effectiveness of the newly optimized program. Results from this preliminary study will be used to design a larger trial comparing outcomes for children and adolescents who complete the virtual Bright Bodies program with those who receive the in-person program.Research Profile
What area of diabetes research does your project cover? What role will this particular project play in preventing, treating and/or curing diabetes?The Bright Bodies intervention is a high-intensity, family-based, multicomponent lifestyle modification program previously shown to be successful in improving health outcomes for children and adolescents with obesity and prediabetes in clinical trials. We will optimize the Bright Bodies intervention for virtual/telehealth delivery and then evaluate its effectiveness and implementation in a 6-month prospective study for children and adolescents with early signs of impaired glucose tolerance (prediabetes). The long-term goal of this research is to improve access to this proven-effective program, ultimately improving population-level health outcomes.
If a person with diabetes were to ask you how your project will help them in the future, how would you respond?I conceptualized the research questions and study design for this project after seeing the challenges inherent in transitioning effective, in-person health interventions, including the Bright Bodies healthy lifestyle program, to virtual platforms during the COVID-19 pandemic. While this particular study will not enroll patients with diabetes, as it focuses on delivering an intervention for youth with impaired glucose tolerance or prediabetes, patients with diabetes will also benefit from knowledge gained regarding how to transition effective lifestyle interventions to telehealth platforms. For patients with both prediabetes and diabetes, future studies may assess the effectiveness and implementation of virtual lifestyle modification interventions as an adjunct to pharmacologic and surgical treatments.
Why important for you, personally, to become involved in diabetes research? What role will this award play?As a pediatric endocrinologist, I see many young patients with impaired glucose tolerance and some with Type 2 diabetes (T2D). From long-term studies including the TODAY study, we know that those with youth-onset T2D have a high risk of complications, which affect most participants by young adulthood. Disparities persist, with higher prevalence of obesity and T2D in individuals from low-income communities and racial/ethnic minorities. As I progressed in my pediatric endocrinology fellowship, my experiences caring for youth with obesity and T2D – as well as my long-standing interest in public health and reducing health inequities – led me to shift my clinical and research focus to addressing pediatric obesity and Type 2 diabetes in my final year of fellowship. Through completion of this research project, I will gain critical skills and preliminary data that will enable me to transition to an independent clinician-scientist by planning for future multi-site interventional studies aiming to treat severe obesity and impaired glucose tolerance in youth and, in the long-term, to prevent progression of prediabetes to Type 2 diabetes.
In what direction do you see the future of diabetes research going?With pediatric onset obesity posing a threat to adult health and the aggressive nature of youth-onset T2D, this research direction aims to develop weight management interventions that are both effective and accessible. Despite the increasing availability of pharmacologic and surgical treatments, intensive behavioral interventions remain the first line and cornerstone of treatment for youth with obesity, including those with prediabetes. Unfortunately, low access and enrollment and high attrition rates often limit the therapeutic benefits of in-person lifestyle modification interventions for pediatric obesity, My overall research vision is to develop and test innovative interventions, including incorporation of telehealth options and remote technologies, to address obesity and T2D in children and adolescents. My long-term goals include increasing scalability of efficacious interventions, accelerating adoption of interventions in different settings serving populations disproportionately impacted by obesity and T2D.