Topics in the Prevention, Treatment and Complications of Type 2 Diabetes 310 perception.(Patton, 1990) Our tenant is that evolutionary adaptation faced with cycles of feast and famine has led to multiple, often subtle biological mechanisms for energy conservation, that are strengthened by social cultural behaviors of nurturing, sharing and preparing for future fasts.With the 21 st c e n t u r y a d v a n c e s o f f o o d d i s t r i b u t i o n a n d refinement, the continuous availability of high energy foods and more sedentary lifestyles now render us maladapted to this new environment.We propose that this clash of perception is best addressed by enhancing learning skills in the community to consider each approach, and develop a new way forward.(Ausubel, 1962) Applying these learning skills to focus on a dialogue, between biological and cultural urges and knowledge of future risk, is required to create sustained changes in behavior that we know can work.From this prospective, success or failure of any obesity intervention in the long haul will be require to 'shift in cultures experience as the basis of reality' (referred to by the Zanders' quotation above) (Zander & Zander, 2002) as the essential ingredient for transformational change.We describe an innovative strategy to create such a transformational change by directly addressing this primary root cause.We provide an educational forum through familyoriented learning rather than health care teaching.This strategy is being tested in a rural Appalachian community in the US that is stable, but geographically and economically isolated.It is at the epicenter of the US epidemic, with some of the highest obesity rates yet recorded.(Pancoska et al., 2009) Within this community, the primary target chosen for intervention is the adolescent with a secondary beneficiary being the adolescents' family.The benefits for this concept extend beyond the question of obesity alone, and offer a transformational model for community self-help and self improvement.Our belief is that even though the infrastructure support for our new paradigm is substantial, it addresses the depth of sophistication needed to create sustained change.Elements of the program are generalizable and could be augmented by changes in local and national policies to improve for the interface between education and health care that could benefit affected communities.In this chapter, we described the evolution and goals of the CAIRN program for rural Appalachia, (Figure 1) and point out the role of some of the multiple key players involved.For any program of this level of sophistication, the individual development will be different, and the key players to influence development will vary in the resources and ideas they contribute; however, it will be the key players who will influence the details of what is developed.We suggest that the common critical elements are community willingness to actively participate, the extensive need for voluntary input from as varied a resource base as possible, the need for help from academia and building a multisource funding base for organization and infrastructure. The Setting: A community network of science clubs for adolescents in rural AppalachiaRural Appalachia, although one of the most scenically beautiful regions of the US with its extended mountain range, is also one of the poorest in the country.The only state entirely in Appalachia, West Virginia (WV), the Mountain State, was initially settled by a wave of Scottish-Irish early immigrants looking for homestead farming.Its later wave of African-American and Caucasian migration came with the railroads to work coal mines.Those who remained despite the later depression are the communities for this sparsely populated www.intechopen.com

Community‐Based Participatory Research (CBPR) has been advocated to translate advances in health care sciences to the community. We describe a novel approach applied to obesity management and diabetes prevention. This takes advantage of a network of science clubs organized by the Health Sciences and Technology Academy (HSTA) for extracurricular activity of disadvantaged high school students in rural Appalachia. Physician scientists and educators provided an intensive summer course on CBPR, ethics, and study design on obesity management and diabetes prevention. Ethical certification for CBPR investigation was obtained for 210 students and 18 mentors for a study on the prevalence of obesity and Type II diabetes within their community. Over a 6‐month period, 989 had a collection of complete analyzable data, of which 103 had diabetes. The proportion with obesity (BMI ≥ 30) was over 50%. The frequency of diabetes was related to increasing BMI. When BMI ≥ 40, the frequency approached 50%, and exhibited a clear familial distribution. We conclude that trained adolescents can effectively conduct CBPR, and obesity and diabetes are more prevalent than previously reported in this community. This experience provides encouragement to conduct future studies to infl uence weight management from high‐risk populations in this medically disadvantaged community.

The prevalence of obesity and diabetes has been studied in adolescent and adult populations in poor, medically underserved rural Appalachia of West Virginia. A web-based questionnaire about obesity and diabetes was obtained in 989 family members of 2 10 Community Based Clinical Research (CBPR) trained adolescent members of a network of 18 science clubs, incorporating 142 families. After age-correction in < 20 years old, 50% of both adolescents and adults were obese. The frequency distribution of obesity was trimodal. In the overall population 10.4% had type 2 diabetes, while 24% of adult, obese subjects had type 2 diabetes. A new metric, the family diabetes risk potential, identified a trimodal distribution of risk potential. In the lowest most common distribution 43% of families had a diabetic family member. In the intermediate distribution, 69% had a diabetic family member, and in the distribution with highest scores all the families had a diabetic member. in conclusion, the poorest counties of rural Appalachia are at crisis level with the prevalence of obesity and diabetes. The distribution of age-corrected obesity and family diabetes risk potential are not normally distributed. We suggest that targeting individual family units at greatest risk offers the most efficient strategy for ameliorating this epidemic.

Classical drug exposure: response studies in clinical pharmacology represent the quintessential prototype for Bench to Bedside-Clinical Translational Research. A fundamental premise of this approach is for a multidisciplinary team of researchers to design and execute complex, in-depth mechanistic studies conducted in relatively small groups of subjects. The infrastructure support for this genre of clinical research is not well-handled by scaling down of infrastructure used for large Phase III clinical trials. We describe a novel, integrated strategy, whose focus is to support and manage a study using an Information Hub, Communication Hub, and Data Hub design. This design is illustrated by an application to a series of varied projects sponsored by Special Clinical Centers of Research in chronic obstructive pulmonary disease at the University of Pittsburgh. In contrast to classical informatics support, it is readily scalable to large studies. Our experience suggests the culture consequences of research group self-empowerment is not only economically efficient but transformative to the research process.