Depression & Insulin Sensitivity in Adolescents
Depression & Insulin Sensitivity in Adolescents
There has been a rise in type 2 diabetes (T2D) rates in adolescents, disproportionately in
 girls from disadvantaged racial/ethnic groups. This group of girls also is at heightened risk
 for depression, and depression and T2D are linked. Depressive symptoms are a risk factor for
 worsening of insulin sensitivity, one if the major precursors to T2D. In preliminary studies,
 the investigators found that a brief cognitive-behavioral therapy group decreased depressive
 symptoms and prevented worsening of insulin sensitivity in adolescent girls at-risk for T2D
 with moderate depressive symptoms. The aims of this study are: 1) to assess the efficacy of a
 cognitive-behavioral therapy depression group vs. a health education control group for
 improving insulin sensitivity and preserving insulin secretion in racially/ethnically diverse
 adolescent girls at-risk for T2D with moderate depressive symptoms over a 1-year follow-up;
 2) to evaluate changes in eating, physical activity, and sleep as explanatory and 3) to test
 changes in cortisol factors as explanatory.
There has been rapid escalation of type 2 diabetes (T2D) rates in adolescents. Early-onset
 T2D (<20y) typically shows a more aggressive course than adult-onset T2D and
 disproportionately affects girls from disadvantaged, racial/ethnic groups. This group of
 girls also is at heightened risk for depression, and depression and T2D are linked.
 Depressive symptoms often manifest in adolescence and are a prospective risk factor for
 worsening of insulin sensitivity, the major physiological precursor-in combination with
 deterioration of pancreatic β-cell capacity to secrete insulin-in the path to T2D. The
 effects of depression on poor insulin sensitivity remain even after accounting for adiposity.
 In theory, depressive symptoms may worsen insulin sensitivity through stress-induced
 behaviors (e.g., disinhibited eating, physical inactivity, sleep disturbance) and
 stress-induced physiological causal mechanisms (e.g., hypercortisolism). The central theme of
 this study is that intervening to reduce depressive symptoms in adolescents at-risk for T2D
 may offer an innovative, targeted approach to ameliorate insulin resistance and to,
 consequently, preserve β-cell function and lessen T2D risk. In preliminary data, the
 investigators found initial evidence that a 6-week cognitive-behavioral group decreased
 depressive symptoms and prevented worsening of insulin sensitivity 1 year later in overweight
 and obese girls with moderate depressive symptoms and a family history of T2D, in comparison
 to a 6-week health education control group. Directly extending these findings, the primary
 aims of this study are: 1) to assess the efficacy of a 6-week cognitive-behavioral depression
 group vs. a 6-week health education control group for improving insulin sensitivity and
 preserving β-cell function in racially/ethnically diverse adolescent girls at-risk for T2D
 with moderate depressive symptoms over a 1-year follow-up; 2) to evaluate changes in eating,
 physical activity, and sleep as behavioral explanatory mediators underlying the relationship
 between decreases in depressive symptoms and improvements in insulin sensitivity and β-cell
 function over 1 year and 3) to test changes in cortisol awakening response, diurnal cortisol
 rhythm, and total daily cortisol output as physiological mechanisms explaining the
 relationship between decreases in depressive symptoms and improvements in insulin sensitivity
 and β-cell function over 1 year.
Inclusion Criteria:

 -  Female

 -  Age 12-17 years

 -  Body mass index (BMI) ≥85th percentile for age & sex

 -  Center for Epidemiologic Studies-Depression Scale (CES-D) >20

 -  English speaking

 -  ≥1 first- or second-degree family member with type 2 diabetes (T2D), prediabetes, or
 gestational diabetes

 -  Good general health

 Exclusion Criteria:

 -  Pregnancy or breastfeeding

 -  Type 2 diabetes as indicated by fasting glucose≥126 mg/dL or 2-hour glucose>200 mg/dL
 or Hba1c>=6.5

 -  Medication affecting mood, weight, cortisol, or insulin sensitivity, including insulin
 sensitizers (e.g., metformin), anti-depressants, and stimulants

 -  Major psychiatric disorder that, in the opinion of the investigators, would impede
 study compliance and necessitate more intensive treatment, including major depressive
 disorder, bipolar disorder, posttraumatic stress disorder, panic disorder,
 obsessive-compulsive disorder, schizophrenia, conduct disorder, alcohol and substance
 abuse, and anorexia/bulimia nervosa

 -  Psychotherapy or structured weight loss program

 -  Active suicidal ideation or suicidal behavior