Type 2 diabetes in children and adolescents: prevention and treatment by lifestyle intervention

Abstract

The primary aim of this thesis was to contribute to the evidence base guiding the prevention and treatment of type 2 diabetes (T2DM) in children and adolescents, specifically through lifestyle intervention. This thesis presents four research studies examining strategies aimed at preventing T2DM in high-risk youth and one study aimed at optimising treatment for youth with T2DM. The four prevention studies focus on the effect of lifestyle interventions, incorporating a dietary and/or exercise component, to lead to sustainable improvements in weight status, cardio-metabolic risk factors and cardiorespiratory fitness, all of which are risk factors for the development of T2DM. For the treatment of T2DM, one study examined whether an intensive very low energy diet (VLED) intervention can lead to rapid weight loss and reversal of T2DM in young people. The key findings of this thesis are: 1. Weight loss can be achieved in children and adolescents with obesity irrespective of the macronutrient distribution of a reduced-energy diet 2. A 12 week exercise program is associated with sustainable improvements in aerobic fitness and anaerobic threshold 3. Prescriptive dietary advice is safe and is associated with long-term improvements in insulin sensitivity and body composition but not weight loss 4. Early weight loss is a strong predictor of long-term obesity treatment outcome 5. Adherence to a VLED can lead to the reversal of T2DM in youth Findings from this thesis provide an improved understanding of the impact of lifestyle interventions in the prevention and treatment of T2DM in children and adolescents. Not only are these findings of immediate benefit to the clinician and patient but they will also be useful in guiding future research in this area.