ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: Pediatr Diabetes. 2020;21(2):224–32. doi: 10.1111/pedi.12976

Short summary: This high-quality, longitudinal lifestyle intervention, with ample funding, had little effect on improving health behaviour profiles of adolescents with T2DM.

Comment: The first sweeping recommendation for adolescents with obesity, and certainly for those with T2DM, is lifestyle change. This study challenged the benefit of this approach. A total of 699 adolescents with T2DM aged 10–17 years were enrolled in a family-based behavioural lifestyle intervention program targeted to promote weight loss. Each family was assigned a personal activity and nutrition leader. The intervention was divided into three cascading stages. In the first stage, the personal leader met with the family weekly for the first 6 to 8 months, and meetings were devoted to increasing physical activity, individual calorie intake goals, self-monitoring and problem-solving. In the second stage, the meetings took place every other week for 12 to 16 months. In the third stage, meetings were monthly for 24 to 28 months. These meetings were devoted to maintenance of healthy lifestyle targets. I believe this is the best possible program one can ask for: professional, personal, longitudinal and funded. Adherence to the program decreased with time, (92% completed relevant assessments at baseline, 76% at 6 months, and 65% at 24 months). Changes that occurred in lifestyle behaviour did not persist at 24 months.

Clinicians need to be aware of the serious and disappointing findings of this study, which reflect the futility of our recommendations for lifestyle changes, and the limited measures we currently have to treat this growing problem.