Yale Researcher Seeks to Prevent Diabetes in Inner-city Youths

A Yale researcher known for helping adolescents control their diabetes has just been awarded a $313,000 federal grant to see if her methods can actually prevent the disease in youths at high risk for it.

Yale School of Nursing Associate Dean for Research Affairs Margaret Grey has previously demonstrated that a behavioral intervention called “coping skills training” can significantly improve metabolic control in youths with type 1 diabetes, often called juvenile diabetes. The gains made by the adolescents in the study were so significant that, if sustained over time, they would result in an average of 25 percent fewer long-term complications. Coping skills training, adapted from a model used to prevent drug abuse in adolescents, helps youths negotiate the constant demands of glucose monitoring, insulin injection and dietary vigilance, while also dealing with the pressures that define the teen years. Methods include problem-solving exercises and role playing.

While type 1 diabetes cannot currently be prevented, type 2 diabetes, which is closely associated with obesity, can often be avoided through sensible weight management. Type 2 diabetes was once seen almost exclusively in adults. But with 25 percent of American teens suffering from obesity, type 2 is becoming increasingly common in younger populations. Obesity is particularly common among inner-city teens. Grey’s new study will explore whether the same coping skills training can be used to support adolescents as they eat healthier and become more active, thereby managing their weight and avoiding the onset of diabetes.

Prevention is crucial with this emerging at-risk group for type 2, said Grey. “Type 2 diabetes is very hard to treat in adolescents,” she said. “Oral agents are not approved for pediatric patients. Insulin actually makes the problem worse because, while it controls blood sugar, it also makes the kids gain more weight. Obviously the key is to prevent obesity in the first place.”

Grey added that even postponing the onset of type 2 diabetes has significant benefits for adolescents. Generally complications -the extremes of which include blindness, amputation and kidney failure-take about 20 years from the time of diagnosis to develop. For most patients, that means that they will have complications when they become elderly. But adolescents developing type-2 diabetes can expect such complications in their thirties.

The study will enroll 50 students from New Haven middle schools where YSN faculty practice in school clinics. Children who are already insulin resistant, a sign that diabetes may be developing, will be included. The children will be followed for a period of one year. Grey will be joined in the research by Sonia Caprio of the Yale Pediatric Weight Management Clinic and Kathleen Knafl, Catherine Gilliss, Gail Melkus and Elaine Gustafson, all of Yale School of Nursing.