Endocrine Abstracts

Introduction: Childhood obesity is associated with complications, such as impaired glucose tolerance and type 2 diabetes mellitus. The gold standard investigation for diagnosing glycaemic alterations is an oral glucose tolerance test (OGTT). Continuous glucose monitors (CGM) are routinely used in the management of children and young people (CYP) with type 1 diabetes mellitus. The aim of our study is to investigate whether CGM is more effective in identifying glycaemic dysregulation, compared to an OGTT in CYP with obesity.

Method: 38 paediatric patients under the care of a tier-3 multidisciplinary weight management service were recruited in this prospective study. Blinded Dexcom G6 CGM devices were inserted into the upper arm to obtain free-living glucose readings on 59 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 effecting glucose levels.

Results: The mean age of the patients was 14.3 years (range: 10.1–16.7) with 52.6% (20/38) being female. The mean weight was 113.1 kg (+21.9 S.D.), mean BMI was 40.8 kg/m² (+7.7 S.D.) and average BMI SDS was +3.6 (+0.5 S.D.). The CGM devices were worn for an average of 8.1 days (range: 3–10) and the mean glucose over this duration was 6.5 mmol (+1.0 S.D.). The coefficient of variation was normal (16.9%; NR <36%). The median percentage time that the glucose levels were within range (3.9–7.8 mmol/L) was 86% (IQR 76–93). The median percentage glucose levels over 7.8 mmol/L were 12% (IQR 3–23) and over 10 mmol/L were 1% (IQR 0–1.7).

Conclusion: The results have shown that the percentage time in range for CYP with obesity (86%) is lower than that seen in healthy participants with no evidence of diabetes mellitus (95%), highlighting for the first time, the prevalence of glycaemic dysregulation in CYP with severe obesity which are missed by routine testing using OGTT. In addition, 1% of glucose readings were higher than 10 mmol/L, raising significant concerns about metabolic health and long-term complications. The study highlights the potential use of CGM devices in the early identification of glycaemic dysregulation, enabling targeted interventions by healthcare professionals to prevent long-term complications.