Effect of Diabetes Self-Management Education (DSME) with and without Motivational Interviewing (MI) on Glycemic Control among Children and Adolescents with Type 1 Diabetes Mellitus: A Randomized Controlled Trial

Background: Type 1 diabetes mellitus (T1DM) is a chronic disease that is difficult to control. Motivational interviewing (MI) is a collaborative style of communication that was designed to strengthen a person’s motivation and commitment to change and improve. We hypothesized that applying MI to diabetes care would lead to improved glycemic control and improved diabetes self-care behavior. Methods: Subjects were T1DM patients aged 10-18 years with HbA1C ≥8% that were recruited from the Outpatient Diabetes Clinic during October 2016 - March 2017. Subjects were randomized into the diabetes self-management education (DSME) or DSME plus MI groups. HbA1C levels, diabetes knowledge test, and diabetes self-care behavioral questionnaire were performed. Results: Thirty-five patients (17 DSME, 18 DSME + MI) completed the study. Baseline HbA1C was not significantly different between groups. At the end of the study, HbA1C levels were not significantly different within or between groups. From pre-intervention to post-intervention, diabetes knowledge scores were significantly increased, and self-care behavioral scores were significantly increased for dietary control and medical taking. Transition to the stages of change action stage was increased from 0 to 12 persons. Conclusions: The effectiveness of MI on glycemic control was not found to be statistically significant at 6 months. However, continuation of DSME in T1DM patients is necessary for improving diabetes knowledge and care. Further study in a larger sample size with longer duration of MI and follow-up is needed to conclusively establish the value of MI on glycemic control in pediatric T1DM

Long-Term Outcomes of Group-Based Treatment for Obese Children and Adolescents

Objective: A 1-year, group-based, treatment program with parental involvement was conducted on 115 obese youths during 2006-2011. The intervention decreased obesity severity. The current study assessed the participants’ long-term weight loss and obesity-related complications. Methods: Participants were invited for a single visit. Their weights, heights, and waist circumferences were measured and compared with corresponding figures at group-based treatment program completion. Factors associated with changed percentage weight-for-height (%W/H) were assessed. Results: There were 43 subjects, including 6 participating telephonically. The median follow-up duration was 5.8 years. %W/H, BMI, and waist circumference increased significantly (p = 0.012, 0.002, and 0.003, respectively). %W/H rose for 26 participants (60.5%; failed group) but declined or stabilized for 17 (39.5%; successful group). The successful-group exercise duration and frequency were significantly higher (p = 0.006 and 0.018, respectively). Three participants had type 2 diabetes, including 1 known case, all in the failed group. Newly-found obesity-related disorders were elevated transaminases (6 participants, with 5 from the failed group), elevated blood pressure (1 failed-group participant), and dyslipidemia (one from each group). Conclusion: Only 40% of the participants maintained long-term weight reduction. Regular exercise was associated with successful weight maintenance. Obesity-related complications were common in the failed group

Dietary Intake and Physical Activity of Thai Children and Adolescents with Type 1 Diabetes Mellitus

Appropriate dietary intake and physical activity (PA) are essential for glycemic control and optimal growth in youth with type 1 diabetes (T1D). Thus, this study aimed to compare dietary intake and PA between youth with T1D and healthy controls. One hundred Thai youth with T1D and 100 age-matched healthy participants were recruited. A 3-day food record was completed and converted into nutrient intake data. PA data were collected via interview. Participants with T1D had a significantly higher mean ± SD carbohydrate (50.8 ± 6.8% vs. 46.2 ± 7.5%, p p p = 0.01) intake compared to controls. Fifty percent of T1D participants and 41% of control participants consumed saturated fat more than recommendations (p = 0.20). Participants with T1D had a higher median (IQR) calcium intake compared to controls (474 (297–700) vs. 328 (167–447) mg/day, p p = 0.04). In addition to the need for counseling that promotes consumption of more dietary fiber and calcium and less saturated fat and sodium, the benefits of performing regular exercise need to be emphasized among youth with T1D

Metabolic Disorders in HIV-Infected Adolescents Receiving Protease Inhibitors

Protease inhibitor (PI) may cause abnormal glucose metabolism, abnormal lipid metabolism, and metabolic syndrome in HIV-infected adults but less well studied in Asian adolescents. This cross-sectional study evaluated anthropometric factors, oral glucose tolerance test, and lipid profiles of perinatally HIV-infected Thai adolescents who had received PI-based antiretroviral therapy for at least 6 months. Eighty adolescents were enrolled [median (IQR) age 16.7 (14.6–18.0) years, 42 males]. Metabolic syndrome, prediabetes, and type 2 diabetes mellitus (T2DM) were found in 8 (10%), 17 (22.1%), and 3 (3.8%) adolescents, respectively. Dyslipidemia was found in 56 (70%) adolescents, with hypertriglyceridemia being the most common type. In multivariate analysis, presence of lipohypertrophy (OR: 25.7, 95% CI: 3.2–202.8; p=0.002) and longer duration of PI use (OR: 1.04, 95% CI: 1.00–1.08; p=0.023) were associated with metabolic syndrome. Obesity (OR: 7.71, 95% CI: 1.36–43.7; p=0.021), presence of lipohypertrophy (OR: 62.9, 95% CI: 4.97–795.6; p=0.001), and exposure to stavudine for ≥6 months (OR: 8.18, 95% CI: 1.37–48.7; p=0.021) were associated with prediabetes/T2DM, while exposure to tenofovir for ≥6 months reduced the risk (OR: 0.17, 95% CI: 0.04–0.78; p=0.022). Metabolic disorders were commonly found in adolescents receiving PI. Careful monitoring and early intervention to modify cardiovascular risk should be systematically implemented in this population particularly those with exposure to stavudine