Limitations and conclusions
depressive
SECONDARY, INSULIN RESISTANCE
Because the randomized trial was powered to detect group changes in our primary outcomes—HbA1c, insulin resistance, and depressive symptoms—these secondary analyses may be limited by low statistical power. For the secondary outcomes reported here, the sample size had acceptable power (80%) to detect approximately a medium size effect (d ~ 0.5) and so was underpowered to detect small effects. Like all self-reports, our food frequency questionnaire may be subject to demand characteristics. The period of follow-up (3 months after post-treatment) may not adequately test the durability of effects. The details of the Cambodian American experience may not apply to all refugee groups, especially younger and newly arriving groups.Modifying nutrition, physical activity and sleep is important for delaying or preventing a rise in HbA1c among high-risk individuals [