RESUMO
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.
Assuntos
Peso Corporal , Diabetes Mellitus Tipo 2/terapia , Hipoglicemiantes/uso terapêutico , Metformina/uso terapêutico , Tiazóis/uso terapêutico , Adolescente , Antropometria , Glicemia/efeitos dos fármacos , Criança , Diabetes Mellitus Tipo 2/fisiopatologia , Combinação de Medicamentos , Feminino , Humanos , Estilo de Vida , Masculino , Fatores de Risco , Resultado do TratamentoRESUMO
OBJECTIVE: To evaluate the effects of behavioral, family-based treatment on disordered eating and child behavior problems for obese 8- to 12-year-old children. STUDY DESIGN: We examined disordered eating in children and parents using the Kids' Eating Disorder Survey (KEDS) and the Binge Eating Scale, respectively; and psychologic problems in children and their parents using the Child Behavior Checklist and Symptom Checklist-90, respectively, in 47 families who participated in a family-based obesity treatment program. RESULTS: Obese children showed significant decreases (-12.5 +/- 13.5) in percent overweight, internalizing problems (-7.0 +/- 7.3), and total behavior problems (-4.8 +/- 6.6) and increases in behavioral competence (3.7 +/- 5.0) over 2 years of measurement; and their parents showed significant decreases in weight (-5.0 +/- 8.3 kg) and reductions in parental distress (-2.3 +/- 7.6) and in disturbed eating and weight-related cognition (-3.2 +/- 5.3). No significant changes were observed in total KEDS (-0.2 +/- 1.9), weight dissatisfaction (-0.3 +/- 1.7), or purging/restricting (0.2 +/- 0.6) scores. Decreases in total KEDS were related to decreases in total behavior problems and externalizing behavior problems. CONCLUSIONS: These results document improvements in child behavior problems and competence and no change in symptoms of disordered eating in a standardized behavioral weight control program.