Endocrine Abstracts

Introduction: Type 2 diabetes mellitus is a known complication of childhood obesity. It is currently diagnosed by undertaking an oral glucose tolerance test (OGTT). Continuous glucose monitoring (CGM) is used predominantly by patients with type 1 diabetes mellitus to monitor glucose levels.

Aim: The aim of the study was to investigate glycaemic variation in children and adolescents with obesity who have had no evidence of pre-diabetes or type 2 diabetes on OGTT, with the use of CGM.

Methods: Children and young people (aged 2-18 years) with obesity (BMI SDS >2) who have had a recent normal OGTT were recruited. Free-living blinded CGM was commenced for a minimum of three days using Dexcom G6 devices, which were successfully inserted into the back of the upper arm.

Results: In total, 13 patients were studied with a mean age of 14.4 years (range: 10.3-16.6). The average BMI was 40.2 kg/m² (+ 7.3 SD) and mean BMI SDS was +3.5 (+ 0.5 SD). The average HbA1c was 34 mmol/mol (5.3%). The CGM devices were worn for an average of 8.0 days (range: 3.4-11.9). The mean glucose of all patients was 6.3 mmol/l (+ 1.2 SD) and the average coefficient of variation was 19.8% (range: 14.3-45.9; normal <36%). Percentage time in and out of range showed a median time between 3.9 and 7.8 mmol/l (70-140 mg/dl) of 83.5% (IQR 79.9-93.7). The median time with glucose levels over 7.8 mmol/l (140 mg/dl) was 12.5% (IQR 2.5-16.7) and median time spent with glucose levels over 10.0 mmol/l (180 mg/dl) was 0.1% (IQR 0-1.6).

Conclusions: The results show that the median time spent in target glucose range was 83.5%, which is lower than the expected 95% seen in healthy, non-diabetic participants. We also found that the patients’ glucose levels were rising above 10 mmol/l (180 mg/dl) occasionally. Glycaemic dysregulation has been identified in our paediatric population with obesity, where conventional investigations were noted to be normal. This shows the potential role for CGM in recognising glycaemic variations earlier, which would help with implementing appropriate treatment strategies.