At-Risk Adolescents and Type 2 Diabetes
Appraised by: Alex Glatt SN, Abby Slaby SN, Brianne Smith SN, Mariah Gustafson SN
NDSU School of Nursing Bismarck
Clinical Question:
For at-risk adolescents (10-19), does weight control and education reduce the future risk of developing Type 2 Diabetes?
Articles:
Amuta, A. O., Barry, A. E., & McKyer, L. J. (2015). Risk perceptions for developing type 2 diabetes among overweight and obese adolescents with and without a family history of Type 2 Diabetes. American Journal of Health Behavior, 786-793. doi: 10.5993/AJHB.39.6.6
Fischetti, N. (2015). Correlates among perceived risk for type 2 diabetes mellitus, physical activity, and dietary intake in adolescents. Pediatric Nursing. 41(3), 126-131.
Grey, M., Jaser, S. S., Holl, M. G., Jefferson, V., Dziura, J., & Northrup, V. (2009). A multifaceted school-based intervention to reduce risk for type 2 diabetes in at-risk youth.Preventive Medicine,49(2-3), 122-128. doi:10.1016/j.ypmed.2009.07.014
Salameh, A. B., Shaheen, A., Al-sheyab, N., Williams, L. M., El-hneiti, M., & Gallagher, R. (2017). Effectiveness of a 12‐week school‐based educational preventive programme on weight and fasting blood glucose in “at‐risk” adolescents of type 2 diabetes mellitus: Randomized controlled trial. International Journal of Nursing Practice, 23(3), 1-8. doi.org/10.1111/ijn.12528
Synthesis of Evidence:
Four articles were reviewed as evidence in this report. The articles included a cross-sectional study, cross sectional descriptive correlational study, randomized control trial, and the fourth article was a single-blinded randomized control trial.
Amuta, Barry & McKyer (2015) conducted a cross sectional study where a total of 7600 college students were contacted via email from a University email list with 909 students responding. For this study, participants were selected based on their body mass index (BMI) status. After the 909 participants were processed, 319 students met inclusion criteria of (being overweight or obese). Participants completed a survey based on what their perception of risks for developing Type 2 Diabetes. After compiling the surveys, researchers found that being female significantly increased the risk perception of developing Type 2 Diabetes (T2D) than being male, along with having a family member diagnosed with T2D was associated with having a higher perceived risk. Also, having a higher BMI and hereditary were two other perceived risks for developing T2D. In turn, beliefs that aging and lifestyle were causes that T2D were not statistically associated with the comparative perceived risk for developing T2D. Participants were also asked what their perceived risk for developing T2D in adulthood (5 years) and over a lifetime were. Researchers found that females had an increased risk perception of developing T2D, along with a family history of T2D, higher BMIs, and hereditary. Aging and lifestyle were not statistically associated with the perceived risks of developing T2D in adulthood and over a lifetime. Findings suggest that overweight and obese adolescents base their risk assessment primarily on non-modifiable risk factors (family history, heredity, gender) with the belief that they are less likely to engage in activities (lifestyle modifications) that would reduce their risk/chances of developing Type 2 Diabetes later in life.
Fischetti (2015) conducted a cross sectional descriptive correlational study. The purpose of this study, examined the relationship of adolescents’ perceptions of risk factors and health promoting behaviors of diet and activity. The final sample consisted of 80 respondents, including 35 males and 45 female students. The National Health and Nutrition Examination Survey (NHANES), 2002 was used to help conduct this research. The survey included: Well-balanced diet and adequate physical activity to decrease risk of developing T2DM in adolescents. The findings show that adolescents who perceived diabetes as a dreaded health risk was positively associated with carbohydrate intake and negatively associated with fat intake suggests that adolescents who dreaded diabetes perceived that fat intake may contribute to obesity. Adolescents may have believed that eating fats was more likely to lead to obesity and potentially T2DM; thus, the adolescent perceived the risk and ate less fat, but did not understand the risks of eating to many carbohydrates.
Grey, Jaser, Holl, Jefferson, Dziura, & Northrup (2009) conducted a
randomized controlled trial to evaluate the impact of school-based interventions on the
improvement outcome of Type 2 Diabetes Mellitus in school-aged children. The study included 198 students at risk for Type 2 Diabetes all in seventh grade. School-based interventions included lifestyle changes such as nutritional and physical education, coping skills training, and health coaching. Schools were randomized into two different intervention groups. Both groups received the same nutrition and activity education, however; the second group received extra education via telephone by health coaches and coping skills training. The results concluded that both intervention groups had some improvement in anthropometric measures, lipids and depressive symptoms. However, BMI was not improved and students who received coping skills training showed greater improvement of metabolic risk than the students who just received nutrition and activity education
Salameh, Al‐sheyab, El‐hneiti, Shaheen, Williams, & Gallagher conducted a single-blinded randomized control trial. This study was done to assess the effectiveness of a 12‐week school‐based educational preventive program for type 2 diabetes by change in weight and fasting blood glucose level in Jordanian adolescents. This study included 400 students who were between the ages 12 and 18 years old. The students were randomly placed into intervention groups. The students were assessed before and after a 12-week intervention for a change in weight as well as fasting blood glucose level. Interventions included preventive instruction education and parent-supported changes. The finding showed that school‐based early prevention intervention effectively reduced weight and fasting blood glucose in Jordanian at‐risk adolescents.
Conclusion:
Of the four articles reviewed, two showed similar result of perceived risk of Type 2 Diabetes and a decreased risk of developing Type 2 Diabetes with adequate education, weight loss, early prevention, adequate exercise, surveys and coping skills training. The other two showed evidence that a weight reduction and coping strategies were effective in decreasing the chance of developing type two diabetes. The research evidence overall provided appropriate information to identify risk factors and ways to decrease the risk of developing T2DM.
Implications for Nursing Practice:
There is evidence that suggests implementing weight control to reduce the future risk for Type 2 Diabetes in at risk adolescents. Two of the articles found that weight reduction and coping strategies were two ways to decrease the risk of developing Type 2 Diabetes in at risk adolescents. However, the two remaining articles did not show clinical evidence in ways to prevent developing Type 2 Diabetes, but what participants believed the perceived risks of developing Type 2 Diabetes were. Education on appropriate nutrition, weight control and adequate exercise are important factors to implement to decrease the risk of developing T2DM in at risk adolescents.