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Impact of lifestyle behavior change on glycemic control in youth with type 2 diabetes
Author(s) -
Kriska Andrea,
El ghormli Laure,
Copeland Kenneth C,
Higgins Janine,
IeversLandis Carolyn E,
Levitt Katz Lorraine E,
Trief Paula M,
Wauters Aimee D,
Yasuda Patrice M,
Delahanty Linda M
Publication year - 2018
Publication title -
pediatric diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.678
H-Index - 75
eISSN - 1399-5448
pISSN - 1399-543X
DOI - 10.1111/pedi.12526
Subject(s) - medicine , glycemic , biostatistics , health science , library science , research center , george (robot) , gerontology , family medicine , public health , diabetes mellitus , medical education , history , art history , nursing , endocrinology , pathology , computer science
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.