ESPE Abstracts

Introduction: Childhood obesity is associated with pre-diabetes and type 2 diabetes mellitus. The gold standard investigation for these is an oral glucose tolerance test (OGTT). The aim of our study is to investigate glycaemic dysregulation in children and young people (CYP) with obesity using continuous glucose monitoring (CGM) and evaluate the effect of intense lifestyle intervention on various complications.

Methods: 34 patients were recruited onto a single-arm study that investigated glycaemic variation using CGM along with anthropometric measurements. These measurements were taken at baseline and at 3-months post-lifestyle intervention (fortnightly telephone reviews by a clinician). PedsQL 4.0 Generic Score questionnaires were used to assess quality of life (QoL) and three-factor eating questionnaire was used for satiety levels.

Results: 23 patients completed the 3-months intervention. Mean age was 13.9 years (range: 10.1-16.7) and 52.2% (12/23) were female. The average BMI (39.1+7.1kg/m² vs 39.5+7.3kg/m²) and BMI SDS (3.5+0.4 vs 3.5+0.5) were similar pre- and post-intervention. There was no significant change in body fat percentage (49.9% vs 49.6%). On CGM, the average glucose at baseline was 6.4mmol/L (+0.8SD) with a mean coefficient of variation of 15.9% (+2.4SD). Percentage time in range (3.9-7.8mmol/L) reduced from 85.7% to 83.1% during the study period. The percentage time over 10mmol/L increased from 0.7% to 1.0%. All patients, except for one post-intervention, had normal OGTT results, despite evidence of glycaemic dysregulation on CGM. HbA1c levels remained stable (33.4 vs 33.8mmol/L). The fasting lipid profile and C-reactive protein improved over 3-months. Alanine transaminases and aspartate transferase levels reduced, with the latter being statistically significant (-1.57iu/L;95%CI 0.10-3.03;P<0.05). QoL improved in both child and parent-reported questionnaires with an increase in the mean psychosocial summary score (child:55.4 vs 60.2/100; parent:50.3 vs 50.5/100) and overall total score (child:58.4 vs 61.5/100; parent:52.3 vs 52.6/100). Better satiety levels were noted with a reduction in uncontrolled eating (40.5 vs 36.3/100) and emotional eating scores (39.9 vs 35.3/100), and an increase in cognitive restraint (38.5 vs 39.7/100).

Conclusion: The results of this study show that intense lifestyle advice and regular contact over 3-months can improve liver function, lipid profiles and inflammation, as well as increasing QoL and satiety in CYP with obesity. The use of CGM has revealed evidence of glycaemic dysregulation, despite normal OGTT and HbA1c levels, demonstrating the ability to identify early abnormalities. Lifestyle intervention was not beneficial in improving glycaemic status highlighting the potential need for considering pharmacotherapy in high risk CYP with obesity.