Kimberly L. Drews

This study examined whether hormonal and body composition responses to 10-weeks of U.S. Army Basic Combat Training (BCT) differ by baseline testosterone and sex. Methods: Male (n=97) and female (n=105) trainees were stratified at baseline as having LOW (men <10.4 nmol/L; women <0.82 nmol/L) or NORMAL baseline testosterone. We measured serum total and free testosterone, sex hormone binding globulin (SHBG), luteinizing hormone (LH) and estradiol (E2) at weeks 0, 2, 4, 6, 8, and 9 and cortisol weekly; dual-energy X-ray absorptiometry (DXA) assessed body composition at week 0 and 9. Linear mixed models tested time and group effects; generalized linear models related baseline testosterone status and testosterone area under the curve with changes in body composition. Results: In LOW women, testosterone increased at each timepoint (all p<0.01), reaching concentrations 53% higher at week 9 compared to week 0 (30.2± 7.8 vs 19.7± 3.2 ng/dl). In men, testosterone increased (LOW: +76%; NORMAL: +23%) across BCT (all p<0.05), except at week 2. Among LOW men, concentrations stabilized by week 4 (344.8± 81.4 ng/dl) and remained normal. Cortisol was highest at baseline and declined in all men and in NORMAL women. LH and E2 remained stable in both sexes, while SHBG declined only in women, independent of baseline testosterone. Neither baseline testosterone nor cumulative exposure were associated with changes in lean or fat mass. Conclusions: SHBG and cortisol trajectories differed by sex and baseline testosterone status. Testosterone changes were sex specific, reflecting an anabolic training environment in men and modest increased androgen availability in LOW women.

Objective: This study examined the effectiveness of behavioral weight management integrated with continuous glucose monitoring (CGM) among adults with overweight or obesity and type 2 diabetes. Methods: This was a two‐arm, parallel, randomized clinical trial. Participants ( n = 151) were randomly assigned to intervention (INT; n = 75) or usual care (UC; N = 76). INT participants received a behavioral weight management program tailored for type 2 diabetes and CGM. UC participants received a session with a dietitian and educational materials. The primary outcome was 6‐month change in HbA1c%. Additional outcomes included changes in weight, waist circumference, blood pressure, CGM metrics, diabetes stress, and treatment satisfaction. Results: INT reduced HbA1c% (−0.87%; 95% CI: −1.17%, −0.57%) more than UC (−0.41%; −0.72%, −0.10%) (difference: −0.46%; −0.89%, −0.03%; p = 0.037). INT had greater reductions in percent body weight compared to UC (difference: −3.2%; −4.9%, −1.5%; p < 0.001). Several CGM metrics improved significantly more in INT than UC, and INT had significantly greater improvements in diabetes treatment satisfaction and regimen‐related diabetes stress relative to UC. Conclusions: Integrating CGM with a digital weight management program produced significantly greater improvements in HbA1c%, body weight, and other glucose metrics compared to UC among adults with overweight or obesity and type 2 diabetes. Trial Registration: ClinicalTrials.gov identifier: NCT05935514 image

The prevalence of type 2 diabetes in youth is increasing at an alarming rate. Identifying potentially modifiable factors modulating glycemic control is critically important to reduce micro and macrovascular complications. In a large cohort of youth-onset type 2 diabetes, self-reported late bedtime on work/school days was independently associated with loss of glycemic control in this longitudinal cohort of young adults with youth-onset type 2 diabetes.

Diabetes exposure during pregnancy affects health outcomes in offspring; however, little is known about in utero exposure to preexisting parental youth-onset type 2 diabetes. Offspring born to participants during the Treatment Options for Type 2 Diabetes in Adolescent and Youth (TODAY) study were administered a questionnaire at the end of the study. Of 457 participants, 37% of women and 18% of men reported 228 offspring, 80% from female participants. TODAY mothers had lower household income (<$25,000) compared to TODAY fathers (69.4% vs. 37.9%, p = 0.0002). At 4.5 years of age (range 0–18 years), 16.7% of offspring were overweight according to the parental report of their primary care provider, with no sex difference. Offspring of TODAY mothers reported more daily medication use compared to TODAY fathers (50/183, 27.7% vs. 6/46, 12.2%, [p = 0.04]), a marker of overall health. TODAY mothers also reported higher rates of recidivism (13/94) than TODAY fathers (0/23). An Individualized Education Plan was reported in 20/94 (21.3%) offspring of TODAY mothers compared to 2/23 (8.7%) of TODAY fathers. This descriptive study, limited by parental self-reports, indicated offspring of participants in TODAY experience significant socioeconomic disadvantages, which, when combined with in utero diabetes exposure, may increase their risk of health and educational disparities.

Through longitudinal analysis from the GLOWING cohort study, we examined the independent and joint relationships between couples’ eating behaviors and gestational weight gain (GWG). Pregnant persons (n = 218) and their non-pregnant partners (n = 157) completed an Eating Inventory. GWG was calculated as gestation weight at 36 weeks minus that at 10 weeks. General linear models were used to examine the relationships between GWG and the pregnant persons, non-pregnant partners, and couples (n = 137; mean of pregnant persons and non-pregnant partners) cognitive restraint (range 0–21), dietary disinhibition (range 0–18), and perceived hunger (range 0–14), with higher scores reflecting poorer eating behaviors. The adjusted models included race/ethnicity, education, income, marital status, and age. The pregnant persons and their non-pregnant partners’ cognitive restraint, dietary disinhibition, and perceived hunger scores were 9.8 ± 4.7, 4.8 ± 3.2, and 4.4 ± 2.5 and 6.6 ± 4.6, 5.4 ± 3.4, and 4.7 ± 3.2, respectively. Higher cognitive restraint scores among the pregnant persons and couples were positively associated with GWG (p ≤ 0.04 for both). Stratified analyses revealed this was significant for the pregnant persons with overweight (p ≤ 0.04). The non-pregnant partners’ eating behaviors alone were not significantly associated with GWG (p ≥ 0.31 for all). The other explored relationships between GWG and the couples’ eating behaviors were insignificant (p ≥ 0.12 for all). Among the pregnant persons and couples, reduced GWG may be achieved with higher levels of restrained eating. Involving non-pregnant partners in programs to optimize GWG may be beneficial.

To assess associations of psychosocial factors with medication adherence in young adults with youth-onset type 2 diabetes in the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY2) cohort. Participants (mean age 26 years) completed validated psychosocial measures. Adherence to oral hypoglycemia agents (OHAs) was assessed with 3-monthly unannounced phone pill counts; insulin adherence by self-report. Logistic and linear regressions identified factors associated with "low-adherence" (<80% of pills/insulin) controlling for confounders. Of 212 participants taking OHAs (67% female, 39% Hispanic, 36% non-Hispanic Black), 69.8% were low-adherent. After adjustment, beliefs that medicines are necessary was associated with lower odds of low-adherence (p = 0.040, dichotomous). Less self-management support (p = 0.008), no healthcare coverage (p = 0.001), ≥1 (p = 0.008)/≥2 (p = 0.045) need insecurities were associated with higher odds of low-adherence. Factors associated with lower % adherence (continuous) were beliefs that medicines are harmful (p < 0.001)/overused (p = 0.007)/less necessary (p = 0.022), low self-management support (p = 0.003), food insecurity (p = 0.036), no healthcare coverage (p < 0.001), ≥1 (p = 0.003)/≥2 (p = 0.018) need insecurities. Of 192 taking insulin (69% female, 36% Hispanic, 41% non-Hispanic Black, 16% non-Hispanic white), 37.0% were low-adherent. Beliefs that medicines are overused (p = 0.009), that diabetes is not serious (p = 0.010), low diabetes self-efficacy (p = 0.035), high distress (p = 0.027), low self-management support (p = 0.001), food insecurity (p = 0.020), ≥1 (p = 0.011)/≥2 (p = 0.015) insecurities increased odds of insulin low-adherence. Poor medication adherence, common in young adults with youth-onset type 2 diabetes, is associated with interfering beliefs, diabetes distress and social factors. We must address these factors to develop tailored interventions for this vulnerable group.