title: In search of quality evidence for lifestyle management and glycemic control in children and adolescents with type 2 diabetes: A systematic review.
abstract: BACKGROUND
  Our purpose was to evaluate the impact of lifestyle behavior modification on glycemic control among children and youth with clinically defined Type 2 Diabetes (T2D).
  
  
  METHODS
  We conducted a systematic review of studies (randomized trials, quasi-experimental studies) evaluating lifestyle (diet and/or physical activity) modification and glycemic control (HbA1c). Our data sources included bibliographic databases (EMBASE, CINAHL®, Cochrane Library, Medline®, PASCAL, PsycINFO®, and Sociological Abstracts), manual reference search, and contact with study authors. Two reviewers independently selected studies that included any intervention targeting diet and/or physical activity alone or in combination as a means to reduce HbA1c in children and youth under the age of 18 with T2D.
  
  
  RESULTS
  Our search strategy generated 4,572 citations. The majority of citations were not relevant to the study objective. One study met inclusion criteria. In this retrospective study, morbidly obese youth with T2D were treated with a very low carbohydrate diet. This single study received a quality index score of < 11, indicating poor study quality and thus limiting confidence in the study's conclusions.
  
  
  CONCLUSIONS
  There is no high quality evidence to suggest lifestyle modification improves either short- or long-term glycemic control in children and youth with T2D. Additional research is clearly warranted to define optimal lifestyle behaviour strategies for young people with T2D.
authors.affiliation: Centre for Nursing & Health Studies, University Drive Athabasca University, AB, Canada.
authors.forename: Steven T
authors.initials: ST
authors.lastname: Johnson
authors.forename: Amanda S
authors.initials: AS
authors.lastname: Newton
authors.forename: Meera
authors.initials: M
authors.lastname: Chopra
authors.forename: Jeanette
authors.initials: J
authors.lastname: Buckingham
authors.forename: Terry T K
authors.initials: TT
authors.lastname: Huang
authors.forename: Paul W
authors.initials: PW
authors.lastname: Franks
authors.forename: Mary M
authors.initials: MM
authors.lastname: Jetha
authors.forename: Geoff D C
authors.initials: GD
authors.lastname: Ball
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000378:metabolism; D002648:Child; D003131:Combined Modality Therapy / Q000379:methods; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000178:diet therapy / Q000628:therapy*; D050528:Diet, Carbohydrate-Restricted; D015444:Exercise; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008019:Life Style; D009765:Obesity / Q000178:diet therapy / Q000628:therapy; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human