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Marrero DG, Blew RM, Palmer KNB, James K, Roe DJ, Hingle MD. Rationale and design of a type 2 diabetes prevention intervention for at-risk mothers and children at a Federally Qualified Healthcare Center: EPIC El Rio Families Study Protocol. BMC Public Health 2021; 21:346. [PMID: 33579240 PMCID: PMC7881686 DOI: 10.1186/s12889-021-10392-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/05/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Exposure to gestational diabetes mellitus (GDM) is associated with increased risk for type 2 diabetes (T2DM) in mothers, and poor cardiovascular health among offspring. Identifying effective methods to mitigate T2DM risk has the potential to improve health outcomes for mothers with a history of GDM and their children. The goal of the EPIC El Rio Families Study is to implement and evaluate the effects of a 13-week behavioral lifestyle intervention on T2DM risk factors in at-risk mothers and their 8- to 12-year-old children. We describe herein the rationale for our specific approach, the adaption of the DPP-based curriculum for delivery to patients of a Federally Qualified Health Center (FQHC), and the study design and methodology. METHODS The effects of the intervention on reduction in excess body weight (primary outcome), hemoglobin A1c, blood pressure, and changes in lifestyle behaviors associated with weight trajectory and T2DM risk in mother-child dyads will be evaluated during a 13-week, group randomized trial wherein 60 mothers and their children will be recruited to the intervention or wait-listed control conditions at one of two FQHC locations. Intervention participants (n = 30) will begin the group program immediately, whereas the wait-listed controls (n = 30) will receive a booklet describing self-guided strategies for behavior change. Associated program delivery costs, acceptability of the program to participants and FQHC staff, and potential for long-term sustainability will also be evaluated. DISCUSSION Successful completion in our aims will produce a scalable program with high potential for replication and dissemination, and estimated intervention effects to inform T2DM prevention efforts on families who use the FQHC system. The results from this study will be critical in developing a T2DM prevention model that can be implemented and scaled across FQHCs serving populations disproportionately burdened by T2DM. TRIAL REGISTRATION ClinicalTrials.gov NCT03781102 ; Date of registration: 19 December 2018.
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Affiliation(s)
- David G Marrero
- University of Arizona Health Sciences Center for Border Health Disparities, 1295 North Martin Ave., P.O. Box 210202, Tucson, AZ, 85721, USA
| | - Robert M Blew
- Department of Nutritional Sciences, College of Agriculture & Life Sciences, The University of Arizona, 1177 E. 4th Street, Shantz Building, Room 328, Tucson, AZ, 85721, USA
- University of Arizona Collaboratory for Metabolic Disease and Prevention, Abrams Public Health Center, 3950 S. Country Club Rd, Tucson, AZ, 85714, USA
| | - Kelly N B Palmer
- University of Arizona Health Sciences Center for Border Health Disparities, 1295 North Martin Ave., P.O. Box 210202, Tucson, AZ, 85721, USA
| | - Kyla James
- Family and Child Wellness at El Rio Community Health Center, 450 W Paseo Redondo, Tucson, AZ, 85701, USA
| | - Denise J Roe
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, 1295 N. Martin Ave., P.O. Box 245210, Tucson, AZ, 85724, USA
| | - Melanie D Hingle
- Department of Nutritional Sciences, College of Agriculture & Life Sciences, The University of Arizona, 1177 E. 4th Street, Shantz Building, Room 328, Tucson, AZ, 85721, USA.
- University of Arizona Collaboratory for Metabolic Disease and Prevention, Abrams Public Health Center, 3950 S. Country Club Rd, Tucson, AZ, 85714, USA.
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Abstract
The FATZO/Pco mouse is the result of a cross of the C57BL/6J and AKR/J strains. The crossing of these two strains and the selective inbreeding for obesity, insulin resistance and hyperglycemia has resulted in an inbred strain exhibiting obesity in the presumed presence of an intact leptin pathway. Routinely used rodent models for obesity and diabetes research have a monogenic defect in leptin signaling that initiates obesity. Given that obesity and its sequelae in humans are polygenic in nature and not associated with leptin signaling defects, the FATZO mouse may represent a more translatable rodent model for study of obesity and its associated metabolic disturbances. The FATZO mouse develops obesity spontaneously when fed a normal chow diet. Glucose intolerance with increased insulin levels are apparent in FATZO mice as young as 6 weeks of age. These progress to hyperglycemia/pre-diabetes and frank diabetes with decreasing insulin levels as they age. The disease in these mice is multi-faceted, similar to the metabolic syndrome apparent in obese individuals, and thus provides a long pre-diabetic state for determining the preventive value of new interventions. We have assessed the utility of this new model for the pre-clinical screening of agents to stop or slow progression of the metabolic syndrome to severe diabetes. Our assessment included: 1) characterization of the spontaneous development of disease, 2) comparison of metabolic disturbances of FATZO mice to control mice and 3) validation of the model with regard to the effectiveness of current and emerging anti-diabetic agents; rosiglitazone, metformin and semaglutide. CONCLUSION Male FATZO mice spontaneously develop significant metabolic disease when compared to normal controls while maintaining hyperglycemia in the presence of high leptin levels and hyperinsulinemia. The disease condition responds to commonly used antidiabetic agents.
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