Lifestyle therapy for the treatment of youth with type 2 diabetes.
Type 2 diabetes (T2D) in youth is a relatively novel condition facing paediatric health care providers. Few experimental trials exist to guide clinical management in this population. Supporting and prescribing modifiable lifestyle behaviours is cornerstone in the management of T2D in adults. Clinical trials in obese adolescents suggest that intensive lifestyle interventions that include both dietary changes and increased physical activity elicit clinically meaningful reductions in weight and improve cardiovascular risk profiles. Observational studies in youth with T2D suggest that better diet quality and increased physical activity are associated with better metabolic control; however, the limited experimental data available does not support these observations. Trials evaluating lifestyle monotherapy for the treatment of hyperglycaemia in youth with T2D do not exist, and the only study evaluating combined lifestyle and pharmacologic therapy did not show additional benefit over pharmacologic treatment with metformin alone. Physiological and psychosocial differences between youth and adults with T2D likely contribute to the differences in the effectiveness of lifestyle therapy for improving glycaemic control. The current review describes these topics in detail and provides recommendations for paediatric health care providers for the promotion of lifestyle therapy for the management of hyperglycaemia and cardiovascular risk factors for youth with T2DM.
Department of Pediatrics and Child Health, Faculty of Medicine, Manitoba Institute of Child Health, University of Manitoba, 511 JBRC 715 McDermot ave., Winnipeg, MB, R3E 3P4, Canada, jmcgavock@mich.ca.
Jonathan
J
McGavock
Allison
A
Dart
Brandy
B
Wicklow
D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology; D001521:Behavior Therapy; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology / Q000628:therapy*; D004038:Diet, Reducing; D015444:Exercise; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008019:Life Style; D015201:Meta-Analysis as Topic; D009765:Obesity / Q000517:prevention & control* / Q000523:psychology; D015995:Prevalence; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012648:Self Care / Q000523:psychology; D016896:Treatment Outcome