Objective: The use of self-reported data to assess diabetes risk in the general population is a key component of the National Diabetes Prevention Program. The American Diabetes Association Diabetes Risk Test (ADADRT) is a popular tool used for this purpose, yet there is paucity of data on its validity in real-world clinical settings. We assessed the performance of ADADRT in identifying undiagnosed prediabetes or diabetes at a Federally Qualified Health Center serving predominantly African Americans. Methods: The ADADRT was administered to participants without pre-existing diagnosis of prediabetes or diabetes and standard validation measures were calculated using HbA1c as the gold standard. Findings are reported for participants who self-identified as being Black or African American (n = 151). Results: HbA1c identified 25.8% of the sample as having prediabetes or diabetes. At the recommended cutoff for ADADRT (i.e., score ≥5) the following measures were observed: proportion of high-risk persons 47.7%, sensitivity 74.4%, specificity 61.6%, positive predictive value 40.3%, negative predictive value 87.3%, Youden Index 36, and area under the receiver-operating characteristic curve 0.68. Conclusion: ADADRT reasonably identifies low income African Americans with high diabetes risk. Findings are comparable to the precursor to ADADRT as validated with nationally representative data. Disclosure C.C. Chima: None. N. Anikpezie: None. B.C. Wade: None. L.S. Pongetti: None. T. Powell: None. B. Beech: None.

Background In 1999, type 2 diabetes mellitus (T2DM) was identified as an emerging epidemic in youth, and racial and ethnic minority youth were identified with high risk. Two decades later, no gold standard T2DM prevention intervention has been established for this population. Objective This study tests the efficacy of a telehealth diabetes prevention intervention for African American (AA) families with children with risk for T2DM. Concurrently, investigators aim to evaluate an implementation strategy for the uptake of the intervention by the University of Mississippi Medical Center’s (UMMC) pediatric weight management clinic. Methods This single-arm trial will enroll 20 parents with overweight or obesity of children (8-11 years) with overweight or obesity, both of whom are at risk for T2DM. Parents will meet in small groups (5 parents per group) weekly for 11 weeks and then monthly for 4 monthly maintenance sessions via videoconference using Wi-Fi–enabled iPads with cellular connectivity. The intervention will be adapted from the National Diabetes Prevention Program and Power to Prevent, a diabetes prevention program tailored for AA families. The same lifestyle intervention facilitated by a racially concordant lifestyle coach trained in the Diabetes Prevention Program will be delivered to all groups (n=4). Participants will be recruited in-person during patient encounters at the UMMC’s pediatric weight management clinic. Sessions will consist of dietary and physical activity behavior change strategies facilitated using problem-solving and goal-setting skills. The implementation strategy has 2 targets: the pediatric weight management clinic site and clinical team and parents of children at risk for T2DM engaged in intensive obesity treatment to prevent T2DM. The multifaceted implementation protocol includes 4 discrete strategies: creating a new clinical team, changing the service site, intervening with families, and promoting organizational readiness for change. Results Recruitment and enrollment began in December 2020, and the intervention is scheduled to be delivered to the first cohort of parents in March 2021. The results are expected to be submitted for publication beginning in November 2021 through 2022. The primary outcome measure for the pilot trial will include changes from baseline to 12 and 30 weeks in the child BMI z score and parent BMI. The implementation evaluation will include multiple measures of feasibility, acceptability, appropriateness, fidelity, and efficacy. This protocol was approved by the UMMC’s Institutional Review Board (#2020V0249). Conclusions The proposed intervention approach is supported by the scientific literature and is scalable given the current and future health care subsidies for telehealth. Findings from this pilot trial will begin to address critical barriers to defining a gold standard lifestyle intervention for AA families with children at risk for T2DM. If effective, the intervention could be feasibly disseminated to treat obesity and prevent T2DM in high-risk AA pediatric populations. International Registered Report Identifier (IRRID) PRR1-10.2196/25699

Aims: This study aimed to evaluate the effectiveness of the Local Authority commissioned large-scale public health service that provided a 6-week school-based weight management intervention for children aged 4–19 years. Methods: A quantitative retrospective cohort study identified participants from 130 schools consisting of 8550 potential children aged 4−19 years across a mixture of Lower Super Output Area (LSOA) deprivation groups. Participants were invited to take part in a 5- to 12-week Healthy Lifestyles intervention with a focus on weight management delivered by OneLife Suffolk between 1 January 2017 and 1 January 2020. This resulted in a final sample of 5163 participants. The following information for each child was collected anonymously: (1) age, (2) gender, (3) preprogramme body mass index (BMI), (4) postprogramme BMI, (5) weight category and (6) LSOA category. Results: Following the 6-week school-based intervention, there was a significant decrease in mean ΔBMI SDS (standardised body mass index) of −0.07 (−14.89%) among participants. Wilcoxon signed-rank test showed a significant change in weight status post 6-week weight management programme (WMP): BMI ( Z = −15.87, p < .001), BMI SDS ( Z = −21.54, p < .001), centile ( Z = −20.12, p < .01) and weight category ( Z = −7.89, p < .001), whereas Mann−Whitney U test showed no statistically significant difference in mean BMI SDS change between gender groups ( p = .24) and Kruskal−Wallis test revealed no statistically significant differences in mean BMI SDS change between child LSOA groups (c2(4) = 1.67, p = .796), school LSOA groups (c2(4) = 4.72, p = .317), ethnic groups (c2(4) = 2.53, p = .640) and weight category at the start of the intervention (c2(3) = 6.20, p = .102). Conclusions: This study contributes to the growing body of evidence demonstrating the efficacy of multicomponent school-based weight management interventions and demonstrates that such interventions can be successfully implemented as part of a wider healthy lifestyles service, without widening health inequalities.

Objective: Common diabetes risk screening tools like the American Diabetes Association Diabetes Risk Test (ADADRT) requires survey administration. We studied if diabetes risk can be assessed from routinely available data in the electronic health record (EHR). Methods: ADADRT was administered to 169 participants without preexisting diagnosis of prediabetes or diabetes, following which the EHR was reviewed for information on ADADRT questions. Standard validation measures were calculated using HbA1c as the gold standard. Results: About 27% of the sample had prediabetes or diabetes. Of the 7 ADADRT variables, physical activity was the least available in the EHR. We observed that modifying ADADRT by dropping physical activity and changing the risk threshold from ≥5 to ≥4 preserves its diagnostic accuracy. The modified ADADRT (cutoff at ≥4) was then approximated using EHR data, yielding the following validation measures: proportion of high-risk persons 56.8%, sensitivity 77.8%, specificity 50.8%, positive predictive value 36.5%, negative predictive value 86.3%, Youden Index 28.6, and area under the receiver-operating characteristic curve 0.64. Conclusion: Diabetes risk score can be estimated using routine EHR data. This could mean a quicker eligibility determination for prediabetes testing and referral to the National Diabetes Prevention Program. Disclosure C.C. Chima: None. N. Anikpezie: None. L.S. Pongetti: None. B.C. Wade: None. T. Powell: None. B. Beech: None.

BACKGROUND In 1999, type 2 diabetes (T2DM) was labeled an emerging epidemic in youth and racial and ethnic minority youth were identified at highest risk. Two decades later, there remains no gold standard T2DM prevention intervention for youth. OBJECTIVE This research protocol aims to test the efficacy of a telehealth diabetes prevention intervention for African American (AA) families with children at risk for T2DM. Concurrently, investigators aim to evaluate a multifaceted implementation strategy for the uptake of the intervention within the pediatric weight management clinic at the University of Mississippi Medical Center (UMMC). METHODS This single arm trial will enroll 20 parents with overweight or obesity of children (8- to 11-years) with overweight or obesity, both of whom are at risk for T2DM. Parents will meet in small groups (5 parents per group) weekly for 11-weeks and then monthly for 4 monthly maintenance sessions via videoconference using Wi-Fi-enabled tablets with cellular connectivity. The intervention will be adapted from the National Diabetes Prevention Program and Power to Prevent, a diabetes prevention program tailored for AA families. The same lifestyle intervention facilitated by a racially concordant Lifestyle Coach trained in the Diabetes Prevention Program will be delivered to all groups (n=4). Participants will be recruited in-person during patient encounters at the pediatric weight management clinic. Sessions will consist of dietary and physical activity behavior change strategies, problem-solving, and goal setting. The implementation strategy has two targets: the pediatric weight management clinic site and clinical team; and parents of children at risk for T2DM engaged in intensive obesity treatment for the prevention of T2DM. The multifacted implementation protocol includes four discrete strategies: creating a new clinical team; changing the service site; intervening with families; and organizational readiness for change. RESULTS Recruitment and enrollment will begin in December 2020 and the intervention is scheduled to be delivered to the first wave of parents in January 2021. Results are expected to be submitted for publication beginning in November 2021 through 2022. The primary outcome measure for the pilot trial will include change from baseline to 12- and 30-weeks in child body mass index (BMI) z-score (index participant and parent BMI. The implementation evaluation will include multiple measures of feasibility, acceptability, appropriateness, fidelity, and efficacy. This protocol has been approved by the UMMC’s Institutional Review Board (#2020V0249). CONCLUSIONS The proposed intervention approach is supported by the scientific literature and is scalable given current and future health care subsidies for telehealth. Findings from this pilot study will begin to address critical barriers to defining a gold standard lifestyle intervention for AA families with children at risk for T2DM. If effective, the intervention could be feasibly disseminated to treat obesity and prevent T2DM in high-risk, AA pediatric populations. CLINICALTRIAL ClinicalTrials.gov: https://clinicaltrials.gov/ct2/show/NCT04618458