Poor lifestyle intervention adherence may dilute effectiveness in youths with type 2 diabetes
medwireNews: Session attendance was only moderate and self-monitoring very poor in youths with type 2 diabetes who participated in the TODAY lifestyle programme, an analysis shows.
“Given the salience of program attendance and self-monitoring to lifestyle weight management established in other populations, future research is needed to understand, develop, and promote strategies and interventions targeting weight loss to achieve improved glycemic control in youth diagnosed with type 2 diabetes”, write Nisha Grover (George Washington University Biostatistics Center, Rockville, Maryland, USA) and co-researchers in Pediatric Diabetes.
The 234 study participants were aged between 10 and 17 years, had type 2 diabetes of less than 2 years’ duration and a body mass index at or above the 85th centile. Between sessions, which varied from 1 week to 1 month apart depending on the phase of the trial, they were asked to log their consumption of unhealthy foods and their physical activity.
Over the 2 years of the trial, less than 40% of the patients met what the research team calls a “lenient threshold” for self-monitoring adherence, which was at least one day’s entry in the log between sessions.
But Grover and colleagues observe that, unlike in previous studies of children with uncomplicated obesity, the patients and their families in TODAY had to deal with complex medication needs, “often in the context of challenging life circumstances and, frequently, an inter-generational burden of diabetes.”
Given this, they suggest that regular session attendance and self-monitoring may have been too demanding. “It also is possible that youth were not experiencing positive results from making the desired behavior changes and rates of self-monitoring suffered as a consequence”, they say.
The youths did better with session attendance than self-monitoring, achieving an average attendance of 65% during the lifestyle change phase, 70% during the maintenance phase and 57% during the continuing contact phase – averaging 60% across the whole trial.
Boys were significantly more likely than girls to achieve the researchers’ target of at least 75% attendance, as were children who were living with both biological parents.
And patients who achieved this goal lost significantly more weight during the first 6 months of the trial and maintained their loss through to 2 years, whereas patients who attended fewer regained weight. They did not, however, improve their glycaemic control, although a previous analysis of TODAY found small improvements in glycaemic control among children who reduced the degree of their overweight by at least 7%.
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