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Effects of lifestyle intervention and metformin on weight management and markers of metabolic syndrome in obese adolescents

By July 1, 2007September 24th, 2020No Comments

LINK TO RESEARCH
https://pubmed.ncbi.nlm.nih.gov/17680902/

PUBLICATION
Journal of the American Academy of Nurse Practitioners

AUTHORS
Kelly A Harden 1, Patricia A Cowan, Pedro Velasquez-Mieyer, Susan B Patton

ABSTRACT
Purpose: The purposes of this study are threefold: to determine what components of
the metabolic syndrome are present in obese adolescents, to determine what
differences exist in the effects of lifestyle intervention versus lifestyle
intervention plus metformin on weight management and select markers of
metabolic syndrome in obese adolescents, and to determine which factors
predict weight loss in obese adolescents treated with lifestyle changes and
metformin.
Data sources: The study was a secondary data analysis utilizing a retrospective chart
review of 63 obese adolescents aged 11 through 18 who were treated for
obesity at the LeBonheur Youth Lifestyle Clinic from January 1, 2000,
through June 30, 2005. Lifestyle interventions included diet, exercise, and
counseling. The medication utilized was metformin. Outcomes evaluated
included body mass index, relative body mass index (RBMI), weight, waist
and hip circumference, blood pressure, serum lipid levels, fasting plasma
glucose, 2-h oral glucose tolerance tests, and insulin levels. Changes in
mean values between groups were evaluated using the General Linear Models
procedure. Logistic regression was utilized to determine which factors
might predict weight loss.
Conclusions: The metformin group (N= 37) tended to be heavier, older, and had more
components of the metabolic syndrome than the nonmetformin group (N= 26).
All components of the metabolic syndrome were present in both groups
(overall prevalence 55%). Both groups had a downward trend in RBMI, a
surrogate marker for weight loss, but only the metformin group had a
significant loss in RBMI points from baseline to end. There was a trend
toward better diastolic blood pressure at 6 months in the metformin group
(p= 0.06), which was not seen in the nonmetformin group. The only
predictors of weight loss were higher RBMI (those who were heavier lost
more) and the absence of type 2 diabetes mellitus (type 2 DM) (those with
type 2 DM were less likely to lose 10 or more points in RBMI).
Implications for practice: All components of the metabolic syndrome are present in obese adolescents.
The use of lifestyle changes and lifestyle changes plus metformin both
produce some degree of weight loss, but subjects on metformin in this study
lost significantly more RBMI points than those on lifestyle changes alone.
Subjects with type 2 DM are less likely to lose weight than those without
type 2 DM. Larger studies and studies with subjects more representative of
the general population need to be carried out to assist in the development
of evidence-based practice guidelines.

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