Endocrine Abstracts

Introduction: Assessing metabolic complications in children and young people (CYP) with obesity can be challenging. In paediatric practice, standardised tests and clear cut-offs for diagnosing insulin resistance remain limited. A Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) cut-off >3.42 has been recommended as identifying those at risk of cardiometabolic risk factors. Total insulin levels (TIL) >300µIU/ml during a five-sample oral glucose tolerance test (OGTT) suggest hyperinsulinism. A 60-minute glucose level >155 mg/dl during an OGTT is a predictor of diabetes risk. The aim of our study was to assess the role of continuous glucose monitoring (CGM) in identifying metabolic risk compared to traditional methods.

Methods: 31 patients (16 F) with an average age of 13.8 years (9.41-16.74) and mean BMI SDS of +3.49 (± 0.45) were involved in a pilot study looking at glycaemic control in childhood obesity. The participants attended two visits for a five-sample OGTT and CGM insertion. The TIL, HOMA-IR and 60-minute glucose values were compared to average blood glucose (BG) and percentage time in range (TIR) on CGM.

Results: The average HOMA-IR (n = 59) was 6.4±3.2. 89.8% of the patients had a value of >3.42. When compared to CGM data, HOMA-IR was positively correlated with average BG (r = 0.08; P = 0.53) and negatively correlated with TIR (r = -0.06; P = 0.66). TIL were calculated (n = 37) with a mean of 785.4µIU/ml (±315.7SD). 97.3% of the results were >300µIU/ml. The TIL was negatively correlated with average BG (r = -0.13; P = 0.45), but unexpectedly positively correlated with TIR (r = 0.16; P = 0.34). The mean 60-minute glucose (n = 42) was 121.3 mg/dl (±24.7SD). Interestingly, only 9.5% of the participants had a level >155 mg/dl. Analysis revealed a positive correlation with average BG (r = 0.29; P = 0.07) and negative correlation with TIR (r = -0.15; P = 0.36). The TIR was significantly corelated with BG (r = -0.84; P <.001) on all three data sets.

Conclusion: These findings highlight the potential of CGM as a valuable tool for assessing glycometabolic status and risk factors in CYP with obesity. Traditional methods often require fasting, hospital admission, and multiple blood tests. CGM offers a less invasive alternative that may provide comprehensive metabolic information. While further research with larger cohorts is needed, these initial results are encouraging for the evaluation of metabolic complications.