Introduction: Childhood obesity (CO) is an important risk factor for the development of many chronic metabolic diseases of the adult age, and one of the most important ones is glucose homeostasis. However, the parameters used to diagnose carbohydrate metabolism disorders in obese children are not always guiding early in detecting pathologies, and may be inadequate to predict the pathologies. For this reason new diagnostic methods are needed. For this purpose, in this study it was deemed suitable to investigate the importance of ambulatory glucose monitoring (AGM) in obese children to evaluate metabolic complications of the glucose homeostasis system in early stages.
Material and methods: After detailed history, anthropometric evaluation and physical examination in seven obese children (according to BMI and BMIpercentile for age and sex) who applied to our pediatric endocrine polyclinic, biochemical and hormonal panels were searched. First of all, ambulatory glucose monitoring (AGM) was applied to all cases and measurements were taken seven times a day for 14 days. Diet and exercise treatment were not performed during these measurements. Especially we wanted them to go on their daily life and habits during this period. Other conventional diagnostic methods (basal and postprandial blood glucose level, HOMA-IR, OGTT, HbAlc) were used to determine glucose homeostasis after 14 days of measurement. Measurements were determined as morning hunger, first and second hours after breakfast, before lunch and dinner, after 1 and 2 hours after meals, and at 0300 in the morning. Measurements of blood glucose level below 70 mg/dl were assessed as hypoglycemia, values above 180 mg/dl were assessed as hyperglycemia.
Results: Although conventional parameters of glucose homeostasis were normal levels of all cases, AGM records showed that fasting glucose intolerance in 4 cases and postprandial glucose intolerance in one case. In the other hand 29 hypoglycemic attacs were recorded during AGM data.
Discussion: As a result; basal and OGTT glucose levels, insulin, HbA1c and HOMA IR index in obese children may not always provide healthy information. Particularly, hypoglycemia will affect all basal values, especially HbA1c. AGM is highly valuable in this group of patients in terms of ensuring a long follow-up of fourteen days in obese cases with this study protocol, assessment of blood glucose fluctuations (hypo-hyperglycaemia) and individual regulation of feeding through demonstration of relationships with nutrition. Another important point, this study may guide physicians to determine if medical treatment is necessary for the cases.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology