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Impact of the Bienestar School-Based Diabetes Mellitus Prevention Program on Fasting Capillary Glucose Levels
A Randomized Controlled Trial
Roberto P. Treviño, MD;
Zenong Yin, PhD;
Arthur Hernandez, PhD;
Daniel E. Hale, MD;
Oralia A. Garcia, MA, MS;
Connie Mobley, PhD
Arch Pediatr Adolesc Med. 2004;158:911-917.
Objective To evaluate the impact of a school-based diabetes mellitus prevention program on low-income fourth-grade Mexican American children.
Design A randomized controlled trial with 13 intervention and 14 control schools.
Setting Elementary schools in inner-city neighborhoods in San Antonio, Tex.
Participants Eighty percent of participants were Mexican American and 94% were from economically disadvantaged households. Baseline and follow-up measures were collected from 1419 (713 intervention and 706 control) and 1221 (619 intervention and 602 control) fourth-grade children, respectively.
Intervention The Bienestar Health Program consists of a health class and physical education curriculum, a family program, a school cafeteria program, and an after-school health club. The objectives are to decrease dietary saturated fat intake, increase dietary fiber intake, and increase physical activity.
Main Outcome Measures The primary end point was fasting capillary glucose level, and the secondary end points were percentage of body fat, physical fitness level, dietary fiber intake, and dietary saturated fat intake. Fasting capillary glucose level, bioelectric impedance, modified Harvard step test, three 24-hour dietary recalls, weight, and height were collected at baseline and 8 months later.
Results Children in the intervention arm attended an average of 32 Bienestar sessions. Mean fasting capillary glucose levels decreased in intervention schools and increased in control schools after adjusting for covariates (–2.24 mg/dL [0.12 mmol/L]; 95% confidence interval, –6.53 to 2.05 [–0.36 to 0.11 mmol/L]; P = .03). Fitness scores (P = .04) and dietary fiber intake (P = .009) significantly increased in intervention children and decreased in control children. Percentage of body fat (P = .56) and dietary saturated fat intake (P = .52) did not differ significantly between intervention and control children.
Conclusion This intervention showed some positive results, but additional research is needed to examine long-term benefits, translation, and cost-effectiveness.
From the Social and Health Research Center, San Antonio, Tex (Dr Treviño); the Department of Pediatrics, Medical College of Georgia, Augusta (Dr Yin); the Department of Pediatrics, Georgia Prevention Institute, Augusta (Dr Yin); the College of Education and Human Development, University of Texas at San Antonio (Dr Hernandez); the Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes (Dr Hale) and the Department of Community Dentistry (Dr Mobley), University of Texas Health Science Center at San Antonio; and the Department of Biobehavioral Health, College of Health and Human Development, Pennsylvania State University, University Park (Ms Garcia).
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