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- Title
Weight management in young adults with type 1 diabetes: The advancing care for type 1 diabetes and obesity network sequential multiple assignment randomized trial pilot results.
- Authors
Igudesman, Daria; Crandell, Jamie; Corbin, Karen D.; Zaharieva, Dessi P.; Addala, Ananta; Thomas, Joan M.; Casu, Anna; Kirkman, M. Sue; Pokaprakarn, Teeranan; Riddell, Michael C.; Burger, Kyle; Pratley, Richard E.; Kosorok, Michael R.; Maahs, David M.; Mayer‐Davis, Elizabeth J.
- Abstract
Aims: Co‐management of weight and glycaemia is critical yet challenging in type 1 diabetes (T1D). We evaluated the effect of a hypocaloric low carbohydrate, hypocaloric moderate low fat, and Mediterranean diet without calorie restriction on weight and glycaemia in young adults with T1D and overweight or obesity. Materials and Methods: We implemented a 9‐month Sequential, Multiple Assignment, Randomized Trial pilot among adults aged 19‐30 years with T1D for ≥1 year and body mass index 27‐39.9 kg/m2. Re‐randomization occurred at 3 and 6 months if the assigned diet was not acceptable or not effective. We report results from the initial 3‐month diet period and re‐randomization statistics before shutdowns due to COVID‐19 for primary [weight, haemoglobin A1c (HbA1c), percentage of time below range <70 mg/dl] and secondary outcomes [body fat percentage, percentage of time in range (70‐180 mg/dl), and percentage of time below range <54 mg/dl]. Models adjusted for design, demographic and clinical covariates tested changes in outcomes and diet differences. Results: Adjusted weight and HbA1c (n = 38) changed by −2.7 kg (95% CI −3.8, −1.5, P <.0001) and −0.91 percentage points (95% CI −1.5, −0.30, P =.005), respectively, while adjusted body fat percentage remained stable, on average (P =.21). Hypoglycaemia indices remained unchanged following adjustment (n = 28, P >.05). Variability in all outcomes, including weight change, was considerable (57.9% were re‐randomized primarily due to loss of <2% body weight). No outcomes varied by diet. Conclusions: Three months of a diet, irrespective of macronutrient distribution or caloric restriction, resulted in weight loss while improving or maintaining HbA1c levels without increasing hypoglycaemia in adults with T1D.
- Subjects
TYPE 1 diabetes; YOUNG adults; REGULATION of body weight; MEDITERRANEAN diet; LOW-calorie diet; ARTIFICIAL pancreases; CALORIC content of foods; LOW-carbohydrate diet; OBESITY
- Publication
Diabetes, Obesity & Metabolism, 2023, Vol 25, Issue 3, p688
- ISSN
1462-8902
- Publication type
Article
- DOI
10.1111/dom.14911