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A Systematic Review of Behavioral Interventions on Children at Risk for Diabetes
Adriana Verdezoto Alvarado1, Kaelyn F Burns2, Sarah E Katz3
1Department of Behavioral Health & Nutrition, College of Health Sciences, University of Delaware, Newark, Delaware.
Insights
Behavioral interventions show promise for improving weight status in children at risk for Type 2 diabetes. However, effects on cardiometabolic markers like glucose and HbA1c were not significant in this review.
Area of Science:
- Pediatrics
- Public Health
- Metabolic Disorders
Background:
- Type 2 diabetes prevention strategies are established in adults, but less is known about their efficacy in children.
- Children at risk for Type 2 diabetes require effective interventions to mitigate cardiometabolic risks.
Approach:
- A systematic review of randomized controlled trials (RCTs) was conducted, searching major databases from September 2011 to September 2021.
- Included studies focused on children aged 6-12 years at risk for Type 2 diabetes, implementing behavioral interventions and assessing cardiometabolic outcomes.
- Risk of bias was evaluated using the revised Cochrane risk-of-bias tool, and dietary quality data were extracted if reported.
Key Points:
- Only 4 studies met the inclusion criteria, with small sample sizes and varying intervention lengths.
- Behavioral interventions significantly improved weight status in 3 studies but did not show significant changes in fasting glucose or HbA1c.
- One study reported a significant improvement in systolic blood pressure, while cholesterol levels remained unchanged across studies.
Conclusions:
- Behavioral-based interventions appear to support weight management and maintain cardiometabolic parameters in at-risk children.
- Future research should incorporate intermediate outcomes like diet quality to better understand intervention effectiveness in preventing Type 2 diabetes in pediatric populations.
Introduction:
In adults, behavioral-based interventions support prevention of Type 2 diabetes; less is known in children. The aim of this systematic review was to examine the impact of behavioral-based interventions on cardiometabolic outcomes among children at risk for diabetes.
Methods:
PubMed, CINAHL Plus with Full Text, PsycINFO, and Web of Science were searched between September 2011 and September 2021. RCTs in children aged 6-12 years at risk for Type 2 diabetes that implemented a behavioral-based intervention and included ≥1 cardiometabolic outcome were eligible. If reported, dietary quality data were extracted. Risk of bias was assessed using the revised Cochrane risk-of-bias tool.
Results:
Of the 2,386 records identified, 4 met the inclusion criteria. Study length ranged from 10 weeks to 24 months, with sample sizes ranging from 53 to 113 participants. Among the 4 studies, there were 5 behavioral-based arms. All studies included weight status outcomes, with 3 finding significant between-group differences. Four studies assessed fasting glucose, and 3 assessed HbA1c; none found significant changes between groups. Of the 4 studies reporting blood pressure outcomes, 1 found a significant between-group difference for systolic blood pressure. Three studies assessed cholesterol and found no changes. No studies reported measures of dietary quality. All studies had some concerns about risk of bias.
Discussion:
Behavioral-based interventions improved weight status and supported the maintenance of cardiometabolic parameters. Stronger consideration of the most important risk factors in children along with intermediate outcomes (e.g., diet quality) may help to elucidate the relationship between behavioral-based interventions and cardiometabolic outcomes.
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