Every Little Step Counts

"Every Little Step Counts" was an effort to create a culturally appropriate healthy lifestyle education program for Latino adolescents at highest risk for Type 2 Diabetes in the Phoenix, Arizona area. Participants were referred to the clinic by local school nurses. They were required to have a BMI in the 95th percentile or higher and also had to meet other criteria based on the American Diabetes Association's screening recommendations for Type 2 diabetes in youth. Before enrolling in the program, laboratory testing for insulin resistance and cholesterol levels was performed. The initial appointment included a discussion of medical history and a physical exam.

Following the exam, children and their parents attended culturally appropriate healthy lifestyle education classes that dealt with issues such as the connection between weight, health, nutrition, and diabetes; roles and responsibilities of the children and their families around communication and health; education about and encouragement of physical activity; self-esteem and self-efficacy for making healthy decisions; and developing an individual healthy behavior plan and strategies for behavior change. Approximately three months after the end of the classes, participants returned for a one-on-one appointment with a dietician where challenges in maintaining behavior change were discussed. Adolescents continued with follow-up sessions on problem solving, dietary adjustments, and other counseling.

To create a culturally appropriate healthy lifestyle educational program for Latino adolescents at highest risk for Type 2 Diabetes.

The promising findings of this program suggest that a community-based diabetes prevention program for obese Latino youth is a feasible strategy for improving health in this high-risk population.

Of the 102 initial enrollees, 60.6% had elevated fasting insulin levels, 9.4% had impaired fasting glucose, 32.1% had high triglyceride levels, 39.4% had high total cholesterol, 68.6% had low HDL cholesterol, and 43.0% had high LDL cholesterol. The 50 youth who returned for post-intervention labs reduced BMI by 3.8% (p < 0.01) over an average of 13 months. They also reduced total cholesterol by 5.4% (p < 0.01) and LDL cholesterol by 8.6% (p < 0.01), and increased HDL cholesterol by 9.3% (p < 0.01). There was a decrease for fasting insulin by 24.0% (p < 0.05). There was no significant difference in the risk factors measured at initial enrollment for youth who completed follow up testing and those who did not complete follow up testing.