Year: 2017
Type: article
Abstract: BACKGROUND: Little is known about the feasibility and impact of lifestyle intervention, determined by change in diet and cardiovascular fitness (CRF), on glycemic control in youth who are overweight with type 2 diabetes. This was examined in the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) clinical trial cohort from across 15 US centers. SUBJECTS: TODAY enrolled 699 youth aged 10 to 17 years with type 2 diabetes <2 years and body mass index ≥85th percentile at baseline. METHODS: Dietary data were collected by an interviewer-administered food frequency questionnaire; CRF was assessed using a submaximal cycle ergometer test. Change from baseline in these variables was analyzed using generalized linear mixed models for both continuous and categorical measures. Models were adjusted for age, baseline HbA1c, treatment group, and medication adherence. Data were collected at baseline, 6, and 24 months. Trial registration ClinicalTrials.gov NCT00081328. RESULTS: At 6 months, ~25% of females and ~33% of males improved CRF. In males, this was related to a decreased HbA1c (P = .001) and a lower percent experiencing glycemic failure (HbA1c ≥8%; P = .007). Females who decreased their saturated fat intake and/or increased their fiber intake had lower HbA1c at month 24 (P = .01 and P = .007, respectively). Males who increased their sweetened beverage intake at 6-month follow-up were at a 1.6-fold higher risk of experiencing glycemic failure (P = .04). CONCLUSIONS: Few youth improved fitness and/or diet over time, although those who did showed a beneficial impact on glycemic outcomes. Although lifestyle behaviors are difficult to change in youth with type 2 diabetes, interventions are needed that are feasible (in scope, complexity, and demands), sustainable, and clinically meaningful.
Source: Pediatric Diabetes
DOI: 10.1111/pedi.12526
Authors: Andrea Kriska, Laure El ghormli, Kenneth C Copeland, Janine Higgins, Carolyn E Ievers-Landis, Lorraine E Levitt Katz, Paula M Trief, Aimee D Wauters, Patrice M Yasuda, Linda M Delahanty, On behalf of the TODAY Study Group
Institutions: University of Pittsburgh, George Washington University, University of Oklahoma Health Sciences Center, University of Colorado Health, University Hospitals Cleveland Medical Center, Rainbow Babies & Children's Hospital, Children's Hospital of Philadelphia, University of Pennsylvania, SUNY Upstate Medical University, The University of Texas at San Antonio Health Science Center, Children's Hospital Los Angeles, Harvard University, Massachusetts General Hospital
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Funders: Bristol-Myers Squibb, Massachusetts General Hospital, Yale University, Children's Hospital of Philadelphia, Children's Hospital Los Angeles, Washington University in St. Louis, University of Oklahoma, Case Western Reserve University, BD, National Institutes of Health, University of Oklahoma Health Sciences Center, University of Colorado Denver, Washington University School of Medicine in St. Louis, National Institute of Allergy and Infectious Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Center for Research Resources, National Center for Advancing Translational Sciences, Children's Hospital of Pittsburgh
Awards: G1007414962, G1013201491, G1074354719, G1092612401, G1106622594, G1114177658, G1205751828, G1250539109, G1264432290, G130883262, G1320905697, G1415392549, G1435996789, G1444064448, G145157345, G1452406238, Management of Pediatric Type 2 Diabetes Mellitus, G1489078085, Multi-Center Study of the Treatment of T2DM in Youth, G149689038, G1541337408, G1585053098, G1598118648, G163357278, G1650331929, G1686083716, G1694266950, G1740463284, G1824217007, G1826705250, G1885171633, G1922015097, G203683428, G2106774427, G2116505794, G2150299440, G2185696043, G2191150108, G2202404319, G2215945170, G2250838539, G2273528374, G2286421763, G2290786691, Case Western Reserve University/Cleveland Clinic CTSA (UL1), G2303287623, G2328791590, G2356874604, G2427822680, G2445381393, G2476129232, G2478336587, G2495941498, G2512295471, G2523152196, G2527449299, G2602742534, G2633030757, G27536180, G278975345, G2805950700, G2835588625, G284260254, G2866075081, G2939982320, G2996031655, G3006617020, G3029844320, G3072735448, G3089208431, G3247330982, G3258243794, G3285764141, G3314594697, G3335888637, G3366866144, G3394423889, Harvard Clinical and Translational Science Center (UL1), General Clinical Research Center, G3499161329, G3523087171, G3600195837, G3655660282, G3709130456, University of Pittsburgh Clinical and Translational Science Institute, G3770033996, G3832661877, G3905150972, G3915705501, G3976977953, G400592931, G4012495729, G4113217758, Type 2 Diabetes in Youth: Beta Cell Preservation, G413336477, G4173951844, G4211906693, G426894015, G4412256101, G4412971278, G4455723224, G4467312596, G4549954026, G4622126127, G46759241, Treatment Alternatives in Pediatric Type 2 Diabetes, G475936976, G4856566612, G4884696667, G492422128, G4978952325, G5021569069, G5176381802, G523627176, G5248153975, G5308902211, G5310199676, G5318790011, Institutional Clinical and Translational Science Award, G547031277, G5495349041, G5539551523, G5562050619, G5634851252, G5649216467, G5682572468, G576336015, G5819948109, G582332544, G5830866086, G5833800221, G5863069804, G5886479391, General Clinical Research Center, G5973391453, G6052675830, G606898507, General Clinical Research Center, G6251626332, G629490077, General Clinical Research Center, G6304731611, G6308904801, G6322753410, G6447481305, G658110454, G6716629419, G6736935772, G6771701953, G6865656351, G6879181497, G6936872475, G6980401035, G7016995429, G7043484107, G7241504061, Washington University Institute of Clinical and Translational Sciences, G728281721, G7361550427, G7382394668, G7432577586, G7435963951, G7466175735, G7503690254, G756633534, G7605449384, G7614789687, G7635370081, G7785802778, G7786997528, G7804600378, Washington University Institute of Clinical and Translational Sciences (UL1), Yale University Clinical and Translational Science Award Program, G8084777885, G8123380152, G8137019193, G819219451, G8202566466, G821538797, G8260572741, G834258283, General Clinical Research Center, G8377578562, G8580283427, G8587357073, G862824631, G8715459185, G8796660116, G881343144, G886101283, G8864794000, G8871414559, G8900235588, G8986017609, G8998828944, G9000109397, Infectious Disease/Basic Microbial Pathogenic Mechanisms, Colorado Nutrition Obesity Research Center, Washington University Institute of Clinical and Translational Sciences, G945364408, Colorado Clinical and Translational Science Institute (UL1)
OpenAlex ID: W2605011891