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Lay- or Expert-Led Interventions for Weight Loss in Overweight Youth, What Works? A Systematic Review and Network Meta-Analysis
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Abstracts / Can J Diabetes 41 (2017) S2–S16
Rationale: The purpose of this study was to test the hypothesis that obesity-risk in adolescence is elevated in children expose to adverse events, in a dose-response manner. Methods: We performed a prospective analysis of 6942 adolescents and their primary care givers in the Growing Up in Ireland child cohort study with measurements obtained in children at 9 and 13 yrs of age. Main exposures were adverse experiences before 9 yrs including several Adverse Child Experience (ACEs) exposures. Main outcome was Objectively measured overweight and obesity at 13 years of age determined using World Health Organization criteria for age and sex. Confounding included objectively measured parental weight status, self-reported physical activity and diet, household income, gender, and family structure. Results: More than 75% of the youth experienced an adverse experience and 17% experienced an ACE- experience before 9 yrs of age. After adjusting for confounding, exposure to any adverse experience was associated with increased odds of overweight/obesity (aOR: 1.15; 95% CI: 1.00–1.32) and obesity (aOR: 1.35; 95% CI: 1.09– 1.69). These associations were stronger among adolescents living in lower income households and if children were exposed to ACEspecific adverse experiences (overweight/obesity- aOR: 1.21; 95% CI: 1.01–1.46; obesity- aOR: 1.50; 95% CI: 1.13–1.98). Conclusions: Childhood adverse experiences, particularly severe adverse experiences, are independently associated with an increased risk of obesity in early adolescence. Increased efforts to assess and address these experiences may improve treatment and prevention efforts for adolescent obesity.
41 Lay- or Expert-Led Interventions for Weight Loss in Overweight Youth, What Works? A Systematic Review and Network Meta-Analysis BHUPENDRASINH F. CHAUHAN, RASHEDA RABBANI, AHMED M. ABOU-SETTA, RYAN ZARYCHANSKI, JONATHAN MCGAVOCK Winnipeg, MB
42 Pregnancy Characteristics and Maternal Risk of Type 2 Diabetes Mellitus CHRISTY WOOLCOTT*, SARAH D. MCDONALD, HUDE QUAN, MOHAMED ABDOLELL, TREVOR DUMMER, LINDA DODDS Halifax, NS Background: Gestational diabetes mellitus (GDM) is known to be associated with an approximately seven-fold increased risk of developing type 2 diabetes mellitus (T2DM) in women. Our objective was to examine other pregnancy characteristics in addition to GDM in relation to T2DM. Methods: A population-based retrospective cohort study was conducted with information about women’s first and subsequent pregnancies from the Nova Scotia Atlee Perinatal Database (1988– 2009) and later T2DM from physician claims and hospital discharge databases (1989–2012). Hazard ratios (HR) with 95% confidence intervals (CI) adjusted for maternal weight, age at first birth, area-level income, smoking, and other pregnancy characteristics were estimated. Results: Among 78,977 women without pre-existing diabetes and complete data, 2969 (3.8%) developed T2DM over a median 14.8 years of follow-up. GDM was associated with the risk of developing T2DM (HR 7.50, CI 6.90–8.15). Among women with a history of GDM, pregnancy characteristics also associated with the risk of T2DM included any history of: Caesarean section (HR 1.16, CI 1.01–1.34); birthweight for gestational age >90th percentile (HR 1.29, CI 1.11– 1.49); neonatal hypoglycemia (HR 1.40, CI 1.16–1.69); and breastfeeding (HR 0.79, CI 0.69–0.91). These characteristics were similarly associated with T2DM risk among women without a history of GDM; additionally, pre-eclampsia (HR 1.54, CI 1.28–1.84) and gestational hypertension (HR 1.69, CI 1.52–1.87) were associated with T2DM in this group. Conclusions: Pregnancy characteristics are associated with the risk of developing T2DM, including hypertensive disorders of pregnancy among women without a history of GDM.
43 Background: Lay or peer-led approaches are an attractive option for public health interventions however their effectiveness for weight loss among overweight youth remains unclear. We conducted a systematic review and network meta-analysis to address this issue. Methods: We searched MEDLINE, Embase, the Cochrane Library, and CINAHL from January 1, 1996 to May 20, 2016 for randomized clinical trials (RCTs) of behavioural weight loss interventions lasting 12 weeks in youth <18 years and stratified into 3 arms:1) lay-led; 2) expert-led; and 3) standard of care. The primary outcomes were change from baseline in weight and body mass index (BMI). Secondary outcomes were BMI-z score, BMI %tile, percent fat, and study withdrawals. Findings: Of 25,586 citations retrieved, 64 RCTs representing 5598 overweight or obese children and adolescents were analyzed (mean age 11.4 years; 40.7% male). Compared to standard weight loss interventions, expert-led interventions yielded significant reductions in weight [median difference (MD) −2.45 Kg, 95% credible interval (CrI) −3.69 to −1.32; 15 RCTs] and BMI [MD −0.90 Kg/m2, 95% CrI −1.60 to −0.28; 14 RCTs]. The magnitude of weight reduction associated with expert-led intervention was maintained even after termination of intervention [MD −2.50, 95% CrI −4.40, −0.83, 6 RCTs]. Layled interventions failed to reach a statistically significant reduction in weight or BMI, compared to control [MD −0.71 kg, 95% CrI −3.40, 1.90 and MD −1.74 kg/m2, 95% CrI −4.56, 0.96] Interpretation: Expert-led approaches are the most effective for weight reduction among overweight youth. Sparse data on layled weight loss intervention warrants further research.
Implementation and Evaluation of the Metformin First Protocol for Management of Gestational Diabetes Mellitus REHA KUMAR, JULIA LOWE, FIONA THOMPSON-HUTCHISON, DAPHNA STEINBERG, ILANA HALPERIN* Toronto, ON Background: In light of growing evidence recommending metformin as first-line drug therapy for gestational diabetes mellitus(GDM), the Diabetes in Pregnancy Clinic at Sunnybrook Hospital implemented the “Metformin First” protocol. Metformin is now offered to all patients requiring medication for management of GDM. Objectives & Methods: A retrospective chart review was conducted of GDM patients seen at the clinic prior to(Jan-Jul2015) and following(Jan-Sept2016) implementation of the protocol to compare pregnancy outcomes. A prospective patient survey was also administered to evaluate impact on patient satisfaction and clinic efficiency. Results: 264 patient charts were reviewed: 159 patients (60%) were treated with lifestyle modifications, 46(17%) with metformin, 40(15%) with insulin and 19(7%) with metformin+insulin. There were no significant differences in rates of pregnancy complications (obstructed labour, infants born large for gestational age, NICU admissions and infant hypoglycemia) or gestational weight gain. Blood glucose control was also comparable and satisfactory across groups. Of the 65 patients initially started on metformin, 21(32%) were switched to or provided supplemental insulin therapy. However, the overall percentage of patients started on insulin—thus requiring individualized patient training—has decreased significantly(33% in 2015 vs 17% in 2016, p=0.003). Following implementation of the protocol,
Abstracts / Can J Diabetes 41 (2017) S2–S16
Rationale: The purpose of this study was to test the hypothesis that obesity-risk in adolescence is elevated in children expose to adverse events, in a dose-response manner. Methods: We performed a prospective analysis of 6942 adolescents and their primary care givers in the Growing Up in Ireland child cohort study with measurements obtained in children at 9 and 13 yrs of age. Main exposures were adverse experiences before 9 yrs including several Adverse Child Experience (ACEs) exposures. Main outcome was Objectively measured overweight and obesity at 13 years of age determined using World Health Organization criteria for age and sex. Confounding included objectively measured parental weight status, self-reported physical activity and diet, household income, gender, and family structure. Results: More than 75% of the youth experienced an adverse experience and 17% experienced an ACE- experience before 9 yrs of age. After adjusting for confounding, exposure to any adverse experience was associated with increased odds of overweight/obesity (aOR: 1.15; 95% CI: 1.00–1.32) and obesity (aOR: 1.35; 95% CI: 1.09– 1.69). These associations were stronger among adolescents living in lower income households and if children were exposed to ACEspecific adverse experiences (overweight/obesity- aOR: 1.21; 95% CI: 1.01–1.46; obesity- aOR: 1.50; 95% CI: 1.13–1.98). Conclusions: Childhood adverse experiences, particularly severe adverse experiences, are independently associated with an increased risk of obesity in early adolescence. Increased efforts to assess and address these experiences may improve treatment and prevention efforts for adolescent obesity.
41 Lay- or Expert-Led Interventions for Weight Loss in Overweight Youth, What Works? A Systematic Review and Network Meta-Analysis BHUPENDRASINH F. CHAUHAN, RASHEDA RABBANI, AHMED M. ABOU-SETTA, RYAN ZARYCHANSKI, JONATHAN MCGAVOCK Winnipeg, MB
42 Pregnancy Characteristics and Maternal Risk of Type 2 Diabetes Mellitus CHRISTY WOOLCOTT*, SARAH D. MCDONALD, HUDE QUAN, MOHAMED ABDOLELL, TREVOR DUMMER, LINDA DODDS Halifax, NS Background: Gestational diabetes mellitus (GDM) is known to be associated with an approximately seven-fold increased risk of developing type 2 diabetes mellitus (T2DM) in women. Our objective was to examine other pregnancy characteristics in addition to GDM in relation to T2DM. Methods: A population-based retrospective cohort study was conducted with information about women’s first and subsequent pregnancies from the Nova Scotia Atlee Perinatal Database (1988– 2009) and later T2DM from physician claims and hospital discharge databases (1989–2012). Hazard ratios (HR) with 95% confidence intervals (CI) adjusted for maternal weight, age at first birth, area-level income, smoking, and other pregnancy characteristics were estimated. Results: Among 78,977 women without pre-existing diabetes and complete data, 2969 (3.8%) developed T2DM over a median 14.8 years of follow-up. GDM was associated with the risk of developing T2DM (HR 7.50, CI 6.90–8.15). Among women with a history of GDM, pregnancy characteristics also associated with the risk of T2DM included any history of: Caesarean section (HR 1.16, CI 1.01–1.34); birthweight for gestational age >90th percentile (HR 1.29, CI 1.11– 1.49); neonatal hypoglycemia (HR 1.40, CI 1.16–1.69); and breastfeeding (HR 0.79, CI 0.69–0.91). These characteristics were similarly associated with T2DM risk among women without a history of GDM; additionally, pre-eclampsia (HR 1.54, CI 1.28–1.84) and gestational hypertension (HR 1.69, CI 1.52–1.87) were associated with T2DM in this group. Conclusions: Pregnancy characteristics are associated with the risk of developing T2DM, including hypertensive disorders of pregnancy among women without a history of GDM.
43 Background: Lay or peer-led approaches are an attractive option for public health interventions however their effectiveness for weight loss among overweight youth remains unclear. We conducted a systematic review and network meta-analysis to address this issue. Methods: We searched MEDLINE, Embase, the Cochrane Library, and CINAHL from January 1, 1996 to May 20, 2016 for randomized clinical trials (RCTs) of behavioural weight loss interventions lasting 12 weeks in youth <18 years and stratified into 3 arms:1) lay-led; 2) expert-led; and 3) standard of care. The primary outcomes were change from baseline in weight and body mass index (BMI). Secondary outcomes were BMI-z score, BMI %tile, percent fat, and study withdrawals. Findings: Of 25,586 citations retrieved, 64 RCTs representing 5598 overweight or obese children and adolescents were analyzed (mean age 11.4 years; 40.7% male). Compared to standard weight loss interventions, expert-led interventions yielded significant reductions in weight [median difference (MD) −2.45 Kg, 95% credible interval (CrI) −3.69 to −1.32; 15 RCTs] and BMI [MD −0.90 Kg/m2, 95% CrI −1.60 to −0.28; 14 RCTs]. The magnitude of weight reduction associated with expert-led intervention was maintained even after termination of intervention [MD −2.50, 95% CrI −4.40, −0.83, 6 RCTs]. Layled interventions failed to reach a statistically significant reduction in weight or BMI, compared to control [MD −0.71 kg, 95% CrI −3.40, 1.90 and MD −1.74 kg/m2, 95% CrI −4.56, 0.96] Interpretation: Expert-led approaches are the most effective for weight reduction among overweight youth. Sparse data on layled weight loss intervention warrants further research.
Implementation and Evaluation of the Metformin First Protocol for Management of Gestational Diabetes Mellitus REHA KUMAR, JULIA LOWE, FIONA THOMPSON-HUTCHISON, DAPHNA STEINBERG, ILANA HALPERIN* Toronto, ON Background: In light of growing evidence recommending metformin as first-line drug therapy for gestational diabetes mellitus(GDM), the Diabetes in Pregnancy Clinic at Sunnybrook Hospital implemented the “Metformin First” protocol. Metformin is now offered to all patients requiring medication for management of GDM. Objectives & Methods: A retrospective chart review was conducted of GDM patients seen at the clinic prior to(Jan-Jul2015) and following(Jan-Sept2016) implementation of the protocol to compare pregnancy outcomes. A prospective patient survey was also administered to evaluate impact on patient satisfaction and clinic efficiency. Results: 264 patient charts were reviewed: 159 patients (60%) were treated with lifestyle modifications, 46(17%) with metformin, 40(15%) with insulin and 19(7%) with metformin+insulin. There were no significant differences in rates of pregnancy complications (obstructed labour, infants born large for gestational age, NICU admissions and infant hypoglycemia) or gestational weight gain. Blood glucose control was also comparable and satisfactory across groups. Of the 65 patients initially started on metformin, 21(32%) were switched to or provided supplemental insulin therapy. However, the overall percentage of patients started on insulin—thus requiring individualized patient training—has decreased significantly(33% in 2015 vs 17% in 2016, p=0.003). Following implementation of the protocol,