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Weight change in the management of youth‐onset type 2 diabetes: the TODAY clinical trial experience
Author(s) -
Marcus M. D.,
Wilfley D. E.,
El ghormli L.,
Zeitler P.,
Linder B.,
Hirst K.,
IeversLandis C. E.,
Buren D. J.,
WaldersAbramson N.
Publication year - 2017
Publication title -
pediatric obesity
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.226
H-Index - 69
eISSN - 2047-6310
pISSN - 2047-6302
DOI - 10.1111/ijpo.12148
Subject(s) - medicine , metformin , overweight , type 2 diabetes , weight management , weight loss , glycemic , obesity , randomized controlled trial , diabetes mellitus , weight change , weight gain , physical therapy , gerontology , body weight , endocrinology
Summary Background The Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) clinical trial documented that metformin plus rosiglitazone, but not metformin plus lifestyle intervention, provided superior durability of glycemic control relative to metformin monotherapy. Objectives We examined weight changes among TODAY participants that completed at least 6 months of treatment, evaluated predictors of lifestyle outcome, and examined whether weight changes were related to cardiometabolic outcomes across treatment arms. Methods The 595 youth with type 2 diabetes, (85.1% of randomized participants aged 11–17 years) completed assessments of weight‐related and cardiometabolic measures at months 0, 6, 12 and 24. Repeated measures models were used to investigate associations over time. Results Lifestyle intervention did not enhance outcome relative to metformin alone and no predictors of response to lifestyle treatment were identified. However, changes in percent overweight across treatment arms were associated with changes in multiple cardiometabolic risk factors, and decreases of ≥ 7% in overweight were associated with significant benefits over 24 months. Conclusions Although adjunctive intensive lifestyle intervention did not improve weight‐related outcomes, weight changes in the full TODAY sample were associated with small, but significant improvements in cardiometabolic status, highlighting the importance of optimizing weight management in youth with T2DM.