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Pediatr Diabetes. 2020 Mar;21(2):224-232. doi: 10.1111/pedi.12976. Epub 2020 Jan 6.

Evaluation of the longitudinal change in health behavior profiles across treatment groups in the TODAY clinical trial.

Author information

1
Department of Pediatrics, Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado.
2
Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
3
The Biostatistics Center, George Washington University, Washington DC.
4
Harvard Medical School, Boston, Massachusetts.
5
Joslin Diabetes Center, Boston, Massachusetts.
6
Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
7
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

Abstract

BACKGROUND:

Individual health behaviors (ie, eating habits and sedentary lifestyle) are associated with type 2 diabetes (T2D). Health behavior profiles specific to adolescents with T2D have not been described.

OBJECTIVE:

To identify health behavior profiles in adolescents with T2D and examine how these profiles change over time.

METHODS:

Diet (via food frequency questionnaire) and activity behaviors (via 3-day physical activity recall) examined at baseline, 6 months, and 24 months from participants in the the Treatment Options for T2D in Adolescents and Youth (TODAY) study were used for this analysis. Latent profile analysis identified profiles of health behaviors within three time points, and latent transition probabilities were estimated to examine the change from baseline to 6 months (n = 450) and baseline to 24 months (n = 415). Multinomial logistic regressions were used to examine if the assigned TODAY treatment group (Metformin [Met], Met + Rosiglitazone [Rosi], or Met + Lifestyle) predicted change in health behavior profiles.

RESULTS:

Three profiles emerged: "most sedentary," "healthy eaters," and "active and eat most." At 6 months, 50% of males and 29% of females in the Met + Lifestyle treatment group improved in their health behavior profile. Among males only, the Met + Lifestyle treatment group were more likely to improve their profiles from baseline to 6 months (P = .01).

CONCLUSIONS:

Three health behavior profiles emerged and shifted over time. A high quality, lifestyle intervention had little effect on improving health behavior profiles. Optimizing outcomes in youth with T2D might require more robust and multifaceted interventions beyond family-level lifestyle, including more extensive psychosocial intervention, novel medication regimen, or bariatric surgery.

KEYWORDS:

adolescence; health behaviors; obesity; profiles; type 2 diabetes

PMID:
31886931
DOI:
10.1111/pedi.12976

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