Background. Estimates are that one third of children will develop type 2 diabetes in their lifetime. Lifestyle changes, including physical activity are established effective tools to prevent and manage type 2 diabetes in adults but the evidence in youth is lacking. Several key questions remain including: (1) Can youth with type 2 diabetes achieve target glycemic control with lifestyle changes alone? (2) Is type 2 diabetes in youth associated with low physical activity and cardiorespiratory fitness? and (3) What is the appropriate intensity of physical activity to reduce the risk for type 2 diabetes in overweight youth? Methods. Three studies were conducted to answer these questions: i) a retrospective chart review to determine the clinical efficacy of lifestyle monotherapy to manage glycemia in youth newly diagnosed with type 2 diabetes; ii) a cross sectional study to test the association between physical activity, cardiorespiratory fitness and type 2 diabetes risk factors in youth; and iii) a randomized controlled trial of physical activity designed to determine the training intensity required to improve insulin resistance and reduce intrahepatic lipid content in overweight youth at risk for type 2 diabetes (interim results presented). Results. Study A. Over 50% of youth newly diagnosed with type 2 diabetes and glycosylated hemoglobin ≤9% were able to achieve target glycemic control for as long as 12 months with lifestyle monotherapy. Study B. Physical activity levels (4905±2075 vs. 6937±2521 vs. 8908±2949 steps/day, p<0.05 vs. healthy weight youth) and cardiorespiratory fitness (23.4±5.9 vs. 26.7±6.0 vs. 36±6.6 ml/kg/min,
ii
p<0.05) are lower in youth with type 2 diabetes versus overweight and healthy weight controls. Intrahepatic lipid is significantly higher (13.0%±14.1 vs. 5.6%±6.2 vs. 1.4%±1.4, p<0.05) and inversely associated with insulin sensitivity (r = -0.40, p<0.001). Study C. Interim analyses present promising trends from a 6-month physical activity intervention.
Conclusions. Lifestyle therapy can be an effective tool to manage new-onset diabetes in certain youth, and is also important in the prevention of type 2 diabetes in youth. Youth with type 2 diabetes are characterized by low levels of physical activity and cardiorespiratory fitness. Interim results are presented from a randomized controlled physical activity trial that we anticipate at completion will provide promising data to guide development of community-based programming to reduce risk for type 2 diabetes in overweight youth.
| Identifer | oai:union.ndltd.org:LACETR/oai:collectionscanada.gc.ca:MWU.1993/4183 |
| Date | 13 September 2010 |
| Creators | Wittmeier, Kristy Diane Marie |
| Contributors | McGavock, Jonathan (Pediatrics and Child Health) Gardiner, Phillip (Kinesiology and Recreation Management), MacNeil, Grant (Medical Rehabilitation) Kriellaars, Dean (Medical Rehabilitation) Pierce, Grant (Physiology) Tremblay, Mark (Healthy Active Living and Obesity Research, Children's Hospital of Eastern Ontario Research Institute) |
| Source Sets | Library and Archives Canada ETDs Repository / Centre d'archives des thèses électroniques de Bibliothèque et Archives Canada |
| Language | en_US |
| Detected Language | English |
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