The impact on metabolic syndrome of school-based type 2 diabetes prevention programs in at-risk youth

Our school-based behavioral interventions have successfully improved body composition and insulin sensitivity among children at risk for T2DM, but little is known about interventional impact on the metabolic syndrome. We performed a secondary analysis to determine the effect of the intervention on the metabolic syndrome from a clinical trial where 198 inner city minority seventh-graders (54% female) with family history of T2DM and BMI ≥85th %’ile received general nutrition and exercise education (GE) and two-thirds were randomly assigned by school to also receive coping skills training (CST) and health coaching. The sample includes 112 participants (n=48 GE, n=63 CST) who completed resting brachial BP and fasting bloodwork before and 12 months after the intervention. Metabolic syndrome is ≥3 of 5 components designated by Cook et al.’s adaptation of NCEP ATP III for adolescents: SBP or DBP ≥90th %’ile; waist circumference ≥90th %’ile; triglycerides ≥110 mg∙dL-1; HDL ≤40 mg∙dL-1; and fasting glucose ≥110 mg∙dL-1. We compared prevalence of metabolic syndrome (Chi-square) and number of individual components (t-tests) by time and intervention. Intervention group did not influence outcomes (p>0.05). Prevalence of metabolic syndrome (25%) and components (BP 60%, waist circumference 37%, triglycerides 24%, HDL 44%, glucose 5%) did not change following intervention (p>0.05), except elevated triglycerides decreased prevalence to 15% (p=0.03). Average number of components per participant (1.7±1.2) did not change over time (p>0.05); however 27% of participants acquired 1-2 components whereas 30% lost 1-2 components. Although our interventions were previously shown to be effective on improving body composition and insulin sensitivity among children at risk for T2DM, it yielded mixed results about stabilization and reversal of metabolic syndrome. Future interventions may consider tailoring to individual risk profiles.