Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia and Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Pediatr Diabetes. 2018 Mar;19(2):191-198. doi: 10.1111/pedi.12555. Epub 2017 Jun 30.
To assess the association of proxies of behavioral adherence to the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) lifestyle program with changes in glycemic control and obesity in a multi-ethnic sample of youth with type 2 diabetes.
The TODAY clinical trial included an intensive lifestyle intervention to promote weight reduction. Adherence was assessed with measures of attendance at intervention sessions and rates of self-monitoring of diet and physical activity by participants and their caregivers. The relation between participant characteristics and consistency of proxies of adherence were examined across 3 phases of intervention.
A total of 234 TODAY youth were randomized to the lifestyle program. Overall rate of session attendance was approximately 60% of planned sessions. Participants with an adequate dose of session attendance (≥75% attended) did not differ from those who attended <75% of sessions in glycemic control, but did have significantly greater reductions in percent overweight compared with those who attended fewer than 75% of sessions. Rates of self-monitoring were low and additional analysis was not possible.
Rates of session attendance were moderate in a lifestyle program for youth with type 2 diabetes, but levels of self-monitoring, considered a key lifestyle change behavior, were low. Glycemic control was not significantly associated with session attendance but reductions in percent overweight were. 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.
评估行为依从性代表的治疗选择 2 型糖尿病在青少年和青年（今日）生活方式计划与血糖控制和肥胖的变化在一个多民族的样本中 2 型糖尿病的青年。
今日临床试验包括一个强化生活方式干预，以促进减肥。通过参与者及其照顾者参加干预课程的次数和自我监测饮食和体育活动的频率来评估依从性。在干预的 3 个阶段，研究了参与者特征与依从性代表的一致性之间的关系。
共有 234 名今日青年被随机分配到生活方式项目中。总体课程出勤率约为计划课程的 60%。参加足够剂量课程的参与者（≥75%出席）与参加不到 75%课程的参与者在血糖控制方面没有差异，但与参加不到 75%课程的参与者相比，超重百分比显著降低。自我监测率较低，无法进行额外分析。
在针对 2 型糖尿病青年的生活方式项目中，课程出勤率适中，但被认为是关键生活方式改变行为的自我监测水平较低。血糖控制与课程出勤率没有显著关联，但与超重百分比的降低有关。鉴于在其他人群中已经确定了项目出勤率和自我监测对生活方式体重管理的重要性，需要进一步研究以了解、制定和促进针对体重减轻的策略和干预措施，从而改善 2 型糖尿病诊断后青年的血糖控制。
