ESPE Abstracts

Introduction: Impaired glucose tolerance and type 2 diabetes mellitus are known complications associated with childhood obesity. At present, an oral glucose tolerance test (OGTT) is the gold standard investigation. Continuous glucose monitors (CGM) are used in children and young people (CYP) with type 1 diabetes mellitus. The aim of our study is to investigate whether the use of a CGM is more effective in identifying glycaemic dysregulation, compared to an OGTT.

Method: In total, 32 paediatric patients who are under the care of a tier 3 multidisciplinary weight management service were included. Blinded Dexcom G6 CGM devices were inserted into the upper arm for a minimum of three days to obtain free-living glucose readings on 51 occasions. On each of these, the patient had a recent normal OGTT prior to the CGM being inserted. None of the patients were on any medicines which effect glucose levels.

Results: The mean age of the patients was 14.2 years (range: 10.1-16.7) with 53.1% (17/32) being female. The mean weight was 112.5kg (+22.2 SD), mean BMI was 40.8kg/m² (+7.6 SD) and average BMI SDS was +3.6 (+0.5 SD). The CGM devices were worn for an average of 8.0 days (range: 3-10) and the mean glucose over this duration was 6.5mmol (+1.0 SD). The coefficient of variation was normal (16.8%; NR <36%). The mean percentage time that the glucose levels were within range (3.9-7.8mmol/L; 70-140mg/dL) was 82.4% (+17.3 SD). The average percentage glucose levels over 7.8mmol/L (140mg/dL) was 14.7% (+17.1 SD) and over 10mmol/L (180mg/dL) was 1.7% (+5.4 SD).

Conclusion: The results have shown that the percentage time in range on CGM for CYP with obesity (82.4%) is lower than that seen in healthy, non-diabetic participants (95%)¹. Interestingly, 1.7% of our readings were glucose levels over 10mmol/L, which was not seen in the healthy cohort¹. Therefore, glycaemic dysregulation was identified in CYP with obesity despite normal OGTT results. This highlights the potential use of CGM devices in the early identification of glycaemic dysregulation, which would enable healthcare professionals to manage in a timely manner and prevent long-term complications.

Reference: ¹ Shah VN et al., Continuous Glucose Monitoring Profiles in Healthy Nondiabetic Participants: A Multicenter Prospective Study. J Clin Endocrinol Metab. 2019