The panel recommends that all patients with PCOS be screened for IGT with a 2-h oral glucose tolerance test. A few members of the AES board recommend alternatively screening women with PCOS for IGT and type 2 DM using an oral glucose tolerance test only in patients with a body mass index of 30 kg/m2 or greater or in lean patients with additional risk factors. Patients with normal glucose tolerance should be rescreened at least once every 2 yr, or more frequently if additional risk factors are identified. Those with IGT should be screened annually for development of type 2 DM. PCOS patients with IGT should be treated with intensive lifestyle modification and weight loss and considered for treatment with insulin-sensitizing agents.

Sex hormone-binding globulin (SHBG) has emerged as one of the multiple genetic and environmental factors that potentially contribute to the pathophysiology of Type 2 diabetes mellitus (T2DM). In addition to epidemiologic studies demonstrating a consistent relationship between decreased levels of serum SHBG and incident T2DM, recent genetic studies also reveal that transmission of specific polymorphisms in the SHBG gene influence risk of T2DM. On the molecular level, elucidation of the multiple interactions between SHBG and its receptors in various target tissues, suggest physiologic roles for SHBG that are more complex than the simple transport of sex hormones in serum. Taken together, these data provide support for an expanded role of SHBG in the pathophysiology of insulin resistance and T2DM.

Background Adherence is a challenge in obesity treatment. Motivational interviewing (MI) may promote patient adherence. MI Values is a randomized controlled trial of MI implemented as an adjunct to an adolescent obesity treatment (T.E.E.N.S.). Objective Assess effects of MI Values on T.E.E.N.S. attrition and adherence. Methods Participants were randomized to MI (n=58) or control (n=41). At weeks 1 and 10, MI participants had brief MI sessions; controls viewed health education videos. All participants continued with T.E.E.N.S. (biweekly dietitian and behavioral support visits; 3x/week supervised physical activity). Assessments were repeated at baseline, 3 and 6-months. T-tests and chi-square analyses examined T.E.E.N.S. attrition and adherence by group. Results Adolescents (N=99) were primarily African American (73%) females (74%); age=13.8±1.8 years, body mass index percentile=98.0±1.2. Compared with controls, MI participants had greater 3-month adherence overall (89.2% vs. 81.0%, p=0.040), and to dietitian (91.3% vs. 84.0%; p=0.046) and behavioral support (92.9% vs. 85.2%; p=0.041) visits, and greater 6-month adherence overall (84.4% vs. 76.2%, p=0.026) and to behavioral support visits (87.5% vs. 78.8%, p=0.011). Conclusions MI enhanced adherence to this obesity intervention. MI Values is the first study to examine the impact of MI on treatment adherence among obese, primarily African American adolescents.

Objective: The aim of this study was to determine the prevalence of the metabolic syndrome at baseline and after 6 months of lifestyle modifi cation among obese adolescents referred to a multidisciplinary weight management program. Methods: A total of 165 obese adolescents were evaluated at baseline, and measurements were repeated in 57 subjects who completed 6 months of the program. Metabolic syndrome was defi ned as having three or more of the following: a body mass index (BMI) >97 th percentile, hypertension, low high-density lipoprotein cholesterol (HDL-C), hypertriglyceridemia, and impaired fasting glucose (IFG). Results: The prevalence of a BMI >97 th percentile, hypertension, hypertriglyceridemia, low HDL-C, and IFG was 92.7, 54.5, 29.1, 26.7, and 2.4%, respectively. The prevalence of the metabolic syndrome at baseline was 30.3%. After 6 months of lifestyle modifi cation, BMI z scores, percent body fat, total cholesterol, and low-density lipoprotein cholesterol (LDL-C) decreased signifi cantly from baseline; however, there was no signifi cant change in the number of subjects demonstrating ≥three criteria of the metabolic syndrome. Conclusions:Approximately one third of the study subjects met the criteria of the metabolic syndrome, emphasizing the growing concern for the future development of premature cardiovascular disease in this high-risk population. Our data suggest that new strategies for lifestyle modifi cation may be needed to improve cardiovascular risk factors signifi cantly among adolescents with obesity.