# Cognitive-Behavioral Therapy and Exercise Training in Adolescents At-Risk for Type 2 Diabetes

> **NIH NIH R01** · COLORADO STATE UNIVERSITY · 2023 · $662,728

## Abstract

Project Summary/Abstract
There has been rapid escalation in adolescent-onset type 2 diabetes (T2D), particularly in females from
historically disadvantaged racial/ethnic groups. Prevention is critical because adolescent-onset T2D often shows
a more aggressive disease course than adult-onset, and effective treatment options remain elusive. Standard-
of-care for T2D prevention includes exercise training to ameliorate insulin resistance, a key physiological
precursor to T2D. Despite short-term benefits, exercise training shows insufficient effectiveness in adolescents
at-risk for T2D. Depression may be explanatory in a considerable subset of teenagers. Adolescence is notable
for increases in depression and decreases in physical activity, especially in females with obesity. Youths'
depression symptoms contribute to worsening insulin resistance over time, independent of BMI (kg/m2), likely
through stress-mediated pathways such as reduced physical activity and fitness. Also, adolescent depression is
associated with decreased physical activity and cardiorespiratory fitness, even after accounting for adiposity,
and depression predicts greater non-adherence to exercise training. The central theme of this proposal is that
an intervention sequence of delivering cognitive-behavioral therapy (CBT) first, followed by intervening with
exercise training second, will offer a targeted, efficacious strategy for improving insulin resistance and
consequently, lowering T2D risk in adolescent females at-risk for T2D with depression symptoms. In a prior
NIH/NIDDK K99/R00 randomized controlled trial (RCT), we found that 6-week group CBT decreased depression
at 6-week follow-up in adolescent females at-risk for T2D with moderately elevated depression, compared to a
6-week didactic health education control group. Adolescents with elevated depression who were randomized to
CBT had lower fasting and 2-hour insulin at 1-year vs. controls. Our preliminary data suggest that CBT's focus
on enhancing frequency/enjoyment of physical activity to combat depressed mood partially explained why
decreasing depression lowered T2D risk. It is not known if CBT is just as efficacious as standard-of-care exercise
training, or whether CBT followed by exercise training results in a maximally potent alleviation of T2D risk in
adolescent females at-risk for T2D with depression symptoms. To address these gaps and directly build on our
prior work, we propose a four-arm RCT to: (1) Compare the efficacy of four 6-week6-week sequences for
improving insulin resistance in N=300 adolescent females at-risk for T2D with elevated depression symptoms:
(i) CBTexercise, (ii) exerciseCBT, (iii) CBT only (CBTcontinue CBT), and (iv) exercise only
(exercisecontinue exercise); (2) Evaluate physical activity/fitness as mediators underlying the depression-
insulin resistance association; and (3) Evaluate underlying mechanisms by which decreasing depression
increases physical activity and improves fitness and in...

## Key facts

- **NIH application ID:** 10592344
- **Project number:** 5R01DK132557-02
- **Recipient organization:** COLORADO STATE UNIVERSITY
- **Principal Investigator:** LAUREN BERGER SHOMAKER
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $662,728
- **Award type:** 5
- **Project period:** 2022-04-01 → 2027-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10592344

## Citation

> US National Institutes of Health, RePORTER application 10592344, Cognitive-Behavioral Therapy and Exercise Training in Adolescents At-Risk for Type 2 Diabetes (5R01DK132557-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10592344. Licensed CC0.

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