Need: Prevention of type 2 diabetes in adolescents living in rural parts of Louisiana.
Intervention: Through screenings, the Adolescent Pre-Diabetes Prevention Program detects the onset of prediabetes. Through nutrition and physical activity education, the program teaches high school students and staff how to adopt healthy lifestyles.
Results: The program has seen an increase in enrollment and continues to see decreases in body weight, body mass index, and A1C levels among participants.
Identifying early signs of prediabetes
presents an opportunity to improve health and prevent the
onset of type 2 diabetes. Healthy habits such as
nutritional eating, exercise, and maintaining a healthy
weight can help lower high blood sugar levels.
The Northeast Louisiana Regional Diabetes Prevention
Collaborative Adolescent Initiative started the
Adolescent Pre-Diabetes Prevention Program, managed by
Richland Parish Hospital. The program's purpose is to
detect the onset of prediabetes and to reduce type 2
diabetes in adolescents living in rural Louisiana.
Through nutrition and physical activity education, the
program teaches high school students and staff how to
adopt healthy lifestyles.
With parental consent, high school students are screened
for A1C levels, weight, height, and blood pressure.
School faculty and staff are also invited to participate.
Program coordinators are assigned to different regions to
work with at least one selected school in each parish,
organizing and conducting screenings and education
The Adolescent Pre-Diabetes Prevention Program includes 6
wellness educational lessons for each level throughout
the academic school year, led by the prediabetes
prevention coordinators. Every year, material from the
previous year is reviewed and expanded upon during each
lesson, which usually lasts 20 minutes. Students are
broken up into small groups of 5 to 9, led by the
prediabetes prevention coordinators, to encourage
participation and facilitate discussion.
Weekly text messages are sent to participating students
and school personnel with health facts and tips to
reinforce the lessons. Through the use of tablets and a
proprietary app, lifestyle questionnaires are also
distributed. Data is stored electronically and has helped
program coordinators learn the patterns, tendencies, and
lifestyle choices of students.
Prediabetes prevention coordinators also lead screenings
at participating high schools and oversee screenings
conducted at school-based health centers. Students are
required to get consent from their parents in order to
participate. Screenings measure the following:
Body Mass Index Percentile (BMI) calculation
A1C blood hemoglobin
Point-of-contact counseling is also offered to students
at the time of the screening. Coordinators review
individual results with students and present potential
goals and strategies that would help them achieve better
results. Without being told what to do, the students are
allowed the freedom to develop and apply strategies in
their own way.
Richland Parish Hospital provides the lab services for
A1C measurements. School-based health centers are able to
bill services to their insurance providers and receive
reimbursement for services. The Adolescent Pre-Diabetes
Prevention Program collects and stores all results from
Out of 10,172 total students in the Adolescent
Pre-Diabetes Prevention Program service area, 593 are
enrolled in the program. Below is a breakdown by grade:
9th grade: 210
10th grade: 214
11th grade: 120
12th grade: 49
Of the total participants enrolled in the program in the
2016-2017 academic year, the following positive results
show that students have adapted and applied principles
presented through the program:
21% of males and 26% of female participants decreased
5% of males and 8% of females lowered their A1C
25% of males and 38% of females lowered their BMI
The Adolescent Pre-Diabetes Prevention Program has been
fully accepted and integrated as a standard part of
participating schools' daily operations.
In 2017, the program was given the Rural Health Program
of the Year award by the Louisiana Rural Health
Association. Knowledge of the program has grown as the
director has presented at the following conferences:
Initially skeptical, school nurses have often waited to
get involved until the program was established, allowing
them time to evaluate its effectiveness. After witnessing
the program's success, many now help the program
coordinators conduct the screenings.
Because rural programs often operate with less resources,
opportunities for sustainability when grant funds end are
essential. School-based health centers have helped this
program become more sustainable, providing staff to
conduct regular screenings, measurements, and
point-of-contact counseling for students. They also
actively recruit students to join the program and can
bill the services to insurance providers for
Data from the screenings was originally stored in
spreadsheet format, but because of the risk of data
corruption, data personnel created a computer program to
more safely and easily collect and extract data.
Key principles for those considering starting a similar
Continue to refine the vision of your project. Remain
flexible and create contingency plans for different
aspects of your program in case your original plans fall
When establishing your service area, evaluate its
geography and the time it will take for travel,
screenings, and educational sessions.
Take into account the various cultures of the schools
and communities that you serve. Respect and apply the
social, economic, ethnic, and cultural differences of
each to your lessons.
Allow time and effort in recruiting staff who display
cultural competency and appropriate skills.
Identify a champion within each school. Secure
participation commitment from school administration,
board members, and school-based health centers. When
starting the program, coordinators made a total of 120
presentations to secure buy-in.
Because of their focus on student health and
connection with the schools, school-based health centers
were the first stop when campaigning for the program.
There was unanimous support and willingness to
participate in a program, even from those outside of the
original service area.
Offer financial incentives for school participation,
returned consent forms, lesson completion, consortium
meeting attendance, and faculty/staff screening
Before screening students, obtain written consent
from parents and students.
Conduct lessons to accompany screenings and vice
Conduct follow-up screenings.
Data collection is key. Not only is it often required
by grants, but it also gives clinical measurements,
increases accountability of people working in their
program, and gives proof of the effectiveness of the
Inviting school personnel to be screened allows them
to experience the program first-hand and can secure their
support. After the first year, many school staff members
were eager to participate in the screenings and
encouraged their students to do the same.
Please contact the models and innovations contact directly for the most complete and current information
about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The
programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural
community should consider whether a particular project or approach is a good match for their community’s
needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep
in mind that changes to the program design may impact results.