Adolescent-mediated Family Diabetes Intervention: American Samoa

An Adolescent-mediated Intervention to Improve Diabetes Prevention and Management in Pacific Islander Families

The goal of this project is to test the feasibility, acceptability, and preliminary efficacy of an adolescent-mediated intervention designed to improve the glycemic control and self-care practices of a parent/grandparent. The preliminary impact of the intervention on adult glycemic control (HbA1c) and self-care behaviors, as well as adolescent risk factors, will be explored with the goal of informing future programs that can be scaled to reduce diabetes burden and eliminate health disparities among at risk, ethnic minority groups.

Study Overview

• Status: Active, not recruiting
• Conditions: Diabetes Mellitus, Type 2
• Intervention / Treatment: Behavioral: Diabetes Intervention; Behavioral: Leadership & Life Skills

Detailed Description

The number of individuals diagnosed with Type 2 Diabetes in the United States (US) has more than doubled since 2000 to over 30 million, with an additional 84.1 million living with prediabetes. One minority group at particular risk is Pacific Islanders (PIs), who are at disproportionate risk and face many barriers (structural and cultural) to engaging in prevention or self-care. To address the critical need for diabetes prevention and treatment programs that target PIs, and building on the family-centered culture, the objective of this project is to pilot test and evaluate a randomized controlled trial of an adolescent-mediated intervention designed to improve the glycemic control and self-care practices of a paired, adult family member with diagnosed diabetes. Dyads (n=160 dyads; an adolescent without diabetes and a parent/grandparent diagnosed with diabetes who share a household) will be randomized. Adolescents will receive either a six-month diabetes intervention or a leadership and life skills-focused control curriculum in groups (n=10 participants in each group). Aside from planned research assessments there will be no contact with the adults in the dyad, who will proceed with their usual diabetes care. To test the hypothesis that adolescents receiving the intervention will be effective conduits of diabetes knowledge and will support their paired adult in the adoption of self-care strategies, the primary efficacy outcomes will be adult glycemic control and cardiovascular risk factors (BMI, blood pressure, waist circumference). Secondarily, since exposure to the intervention may encourage positive behavior change in the adolescent themselves similar outcomes will be measured in the adolescents. Outcomes will be measured at baseline, at the end of the active intervention phase (six months post-randomization) and at 12-months post-randomization, to examine maintenance of intervention effects in the absence of contact. To determine potential for long-term sustainability and scale up, program acceptability, feasibility, fidelity, reach, and cost will be examined. Successful completion of the study aims and proof of efficacy would produce an innovative, scalable program with high potential for replication in other similar, low-resource, family-centered, ethnic minority groups across the US who are the ideal beneficiaries of innovations to reduce chronic disease risk and eliminate health disparities.

• Study Type: Interventional
• Enrollment (Estimated): 360
• Phase: Not Applicable

Contacts and Locations

Study Locations

• American Samoa
  • Pago Pago, American Samoa
    • OLaGA Research Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 14 years and older (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

Adolescent

• 14-17 years of age
• Samoan ethnicity
• Shares a household with a parent, legal guardian, or grandparent with type II diabetes
• Willing and able to consent to participation
• Able to participate in group sessions after school or on Saturday mornings

Adult

• Samoan ethnicity
• Diagnosed with type II diabetes at least 12 months prior to study enrollment
• HbA1c >= 6.5%
• Prescribed medication (tablets or insulin) to control their diabetes
• Willing and able to consent to participation
• Willing and able to consent to adolescent's participation

Exclusion Criteria:

Adolescent

• Planning to become pregnant during the study period (any adolescent who becomes pregnant will be excluded from analysis)
• Planning to leave American Samoa in the next 18 months

• Participants will be excluded if they report any of the following:

  • Uncontrolled hypertension (systolic >180 mmHg or diastolic >105 mmHg)
  • Heart attack, stroke, or transient ischemic attack in the past year
  • Treatment for cancer
  • Chest pain or shortness of breath with minimal activity
  • Chronic lung disease, or asthma requiring home oxygen therapy
  • Contraindications to moderate physical activity
  • Inability to read/speak Samoan and/or English.
• Overt diabetes (HbA1c ≥6.5%) based on point-of-care testing during the screening process

Adult

• Planning to become pregnant during the study period (any adult who becomes pregnant will be excluded from analysis)
• Planning to leave American Samoa in the next 18 months

• Participants will be excluded if they report any of the following:

  • Uncontrolled hypertension (systolic >180 mmHg or diastolic >105 mmHg)
  • Heart attack, stroke, or transient ischemic attack in the past year
  • Treatment for cancer
  • Chest pain or shortness of breath with minimal activity
  • Chronic lung disease, or asthma requiring home oxygen therapy
  • Contraindications to moderate physical activity
  • Inability to read/speak Samoan and/or English.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Diabetes Intervention; 12-session behavioral intervention covering diabetes pathology, self-monitoring, medication adherence, identifying and responding to emergency situations, diet, physical activity, health care utilization and maintaining healthy habits.	Behavioral: Diabetes Intervention; A 12-session group-based intervention that will target diabetes knowledge and leadership and communication skills through facilitated discussion and experiential learning.
Active Comparator: Leadership & Life Skills; 12-session leadership and life skills intervention focusing on adolescent self-esteem, self-efficacy, communication skills, mindfulnesss, healthy habits.	Behavioral: Leadership & Life Skills; A 12-session group based intervention that will teach leadership and life skills (planning strategies, leadership values, emotional awareness, effective reasoning skills)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Adult Glycemic Control (HbA1c) 0-6 months	Glycated hemoglobin (marker of long term glycemic control)	0 - 6 months
Change in Adult Glycemic Control (HbA1c) 0-12 months	Glycated hemoglobin (marker of long term glycemic control)	0 - 12 months
Change in Adult Glycemic Control (HbA1c) 6-12 months	Glycated hemoglobin (marker of long term glycemic control)	6 - 12 months
Change in Adult Body Mass Index (BMI) 0-6 months	Body mass index (measure of weight control)	0 - 6 months
Change in Adult Body Mass Index (BMI) 0-12 months	Body mass index (measure of weight control)	0 - 12 months
Change in Adult Body Mass Index (BMI) 6-12 months	Body mass index (measure of weight control)	6 - 12 months
Change in Adult Blood Pressure (BP) 0 - 6 months	Blood Pressure (marker of hypertension risk)	0 - 6 months
Change in Adult Blood Pressure (BP) 0 - 12 months	Blood Pressure (marker of hypertension risk)	0 - 12 months
Change in Adult Blood Pressure (BP) 6 - 12 months	Blood Pressure (marker of hypertension risk)	6 - 12 months
Change in Adult Waist Circumference (WC) 0 - 6 months	Waist circumference (measure of weight control)	0 - 6 months
Change in Adult Waist Circumference (WC) 0 - 12 months	Waist circumference (measure of weight control)	0 - 12 months
Change in Adult Waist Circumference (WC) 6 - 12 months	Waist circumference (measure of weight control)	6 - 12 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Adolescent Glycemic Control (HbA1c) 0 - 6 months	Glycated hemoglobin (marker of long term glycemic control)	0 - 6 months
Change in Adolescent Glycemic Control (HbA1c) 0 - 12 months	Glycated hemoglobin (marker of long term glycemic control)	0 - 12 months
Change in Adolescent Glycemic Control (HbA1c) 6 - 12 months	Glycated hemoglobin (marker of long term glycemic control)	6 - 12 months
Change in Adolescent Body Mass Index (BMI) 0 - 6 months	Body mass index (measure of weight control)	0 - 6 months
Change in Adolescent Body Mass Index (BMI) 0 - 12 months	Body mass index (measure of weight control)	0 - 12 months
Change in Adolescent Body Mass Index (BMI) 6 - 12 months	Body mass index (measure of weight control)	6 - 12 months
Change in Adolescent Blood Pressure (BP) 0 - 6 months	Blood Pressure (marker of hypertension risk)	0 - 6 months
Change in Adolescent Blood Pressure (BP) 0 - 12 months	Blood Pressure (marker of hypertension risk)	0 - 12 months
Change in Adolescent Blood Pressure (BP) 6 - 12 months	Blood Pressure (marker of hypertension risk)	6 - 12 months
Change in Adolescent Waist Circumference (WC) 0 - 6 months	Waist circumference (measure of weight control)	0 - 6 months
Change in Adolescent Waist Circumference (WC) 0 - 12 months	Waist circumference (measure of weight control)	0 - 12 months
Change in Adolescent Waist Circumference (WC) 6 - 12 months	Waist circumference (measure of weight control)	6 - 12 months

Collaborators and Investigators

• Sponsor: Yale University
• Collaborators: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
• Investigators: Principal Investigator: Nicola L Hawley, PhD, Yale University School of Public Health

Study record dates

Study Major Dates

• Study Start (Actual): July 7, 2022
• Primary Completion (Estimated): December 31, 2025
• Study Completion (Estimated): December 31, 2025

Study Registration Dates

• First Submitted: April 26, 2022
• First Submitted That Met QC Criteria: April 26, 2022
• First Posted (Actual): May 2, 2022

Study Record Updates

• Last Update Posted (Actual): July 25, 2025
• Last Update Submitted That Met QC Criteria: July 23, 2025
• Last Verified: July 1, 2025

More Information

Terms related to this study

• Keywords: Adolescent; Diabetes Mellitus; Pacific Islander; American Samoa
• Additional Relevant MeSH Terms: Endocrine System Diseases; Metabolic Diseases; Glucose Metabolism Disorders; Diabetes Mellitus, Type 2; Diabetes Mellitus
• Other Study ID Numbers: 2000031325; 1R01DK128277-01A1 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: De-identified data may be shared with other researchers for the purpose of analyses agreed upon with the Principal Investigator

IPD Sharing Time Frame

Study protocol has been published and is available at: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0279084

Detailed intervention and control curricula will be available in August 2024 upon completion of data collection.

• IPD Sharing Access Criteria: All materials will be made publicly available.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No