title: Weight change in the management of youth-onset type 2 diabetes: the TODAY clinical trial experience.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: M D
authors.initials: MD
authors.lastname: Marcus
authors.affiliation: Department of Psychiatry, Washington University School of Medicine, St Louis, MO.
authors.forename: D E
authors.initials: DE
authors.lastname: Wilfley
authors.affiliation: George Washington University, Biostatistics Center, Rockville, MD.
authors.forename: L
authors.initials: L
authors.lastname: El Ghormli
authors.affiliation: Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine, Aurora, CO.
authors.forename: P
authors.initials: P
authors.lastname: Zeitler
authors.affiliation: Division of Diabetes, Endocrinology and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD.
authors.forename: B
authors.initials: B
authors.lastname: Linder
authors.affiliation: George Washington University, Biostatistics Center, Rockville, MD.
authors.forename: K
authors.initials: K
authors.lastname: Hirst
authors.affiliation: Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, OH.
authors.forename: C E
authors.initials: CE
authors.lastname: Ievers-Landis
authors.affiliation: Department of Psychiatry, Washington University School of Medicine, St Louis, MO.
authors.forename: D J
authors.initials: DJ
authors.lastname: van Buren
authors.affiliation: Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine, Aurora, CO.
authors.forename: N
authors.initials: N
authors.lastname: Walders-Abramson
mesh_terms: D000293:Adolescent; D000886:Anthropometry; D001786:Blood Glucose / Q000187:drug effects; D001835:Body Weight; D002648:Child; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology / Q000628:therapy*; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008019:Life Style; D008297:Male; D008687:Metformin / Q000627:therapeutic use*; D012307:Risk Factors; D013844:Thiazoles / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D004338:Drug Combinations; D007004:Hypoglycemic Agents; D013844:Thiazoles; C471074:rosiglitazone-metformin combination; D008687:Metformin
keywords: behavioral weight control; cardiometabolic risk; lifestyle; type 2 diabetes