Session/Event: Emerging Science: Highlights from Rapid Science Submissions

(ES03-22) Improving Glycemic Control Among Children & Adolescents With Obesity & Pre-Diabetes via Continuous Glucose Monitoring: A Novel Use for Existing Technology

On Demand

Presenting Author(s)

Timothy P. Foster, MD

Pediatric Endocrinology Fellow
University of Florida
Gainesville, Florida, United States

Disclosure: Disclosure(s): No relevant financial relationship(s) with ineligible companies to disclose.

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Co-Author(s)

ZM

Zachary Z. Mayer

University of Florida
MT

Michael A. Tan

University of Florida
XC

Xiaofei Chi, MS

Data Management Analyst III
University of Florida
Gainesville, Florida, United States
MG

Matthew J. Gurka, PhD

Professor and Associate Chair
University of Florida
Gainesville, Florida, United States
AB

Angelina Bernier, MD

University of Florida

Objectives: Behavioral change in dietary intake is critical to altering the trajectory from prediabetes to diabetes in obesity. Continuous glucose monitors (CGMs) provide timely glucose measurements and are effective tools in diabetes, but are not indicated for pre-diabetes. CGMs can show the real-time effect of food choices on blood glucose (BG) and may cause behavioral change in food selection. The goal of this pilot is to determine the feasibility of introducing CGMs to adolescent patients with obesity and pre-diabetes and determine if diabetes risk or eating habits are modified by awareness of glucose excursions.

Methods:

This cross-sectional study in 22 children aged 10-17 years recruited from the University of Florida Pediatric Metabolic & Obesity Clinic with pre-diabetes based on HbA1c of 5.7-6.4% and BMI >95th percentile for age. Baseline demographics, BMI, HbA1c, 24-hour dietary recall, and 2-week blinded CGM data were obtained prior to patients receiving a Freestyle Libre CGM. Supplies were provided for 10 weeks of unblinded CGM wear-time. After 2 weeks patients completed a telemedicine visit with a registered dietician and CDE to review BG trends related to dietary history. Patients returned for a clinic follow-up at 3 months, where changes in HbA1c, BMI, CGM data, and 24-hour dietary recall were compared to baseline measurements.

Results:

14 of 22 (64%) recruited participants (12 female, average age 14 years, 55% Black, 9% Hispanic) returned for 3-month follow-up with CGM data. Mean CGM wear-time was 48% (range 33-62). Mean CGM glucose decreased from 99 to 92 mg/dl (p= 0.01) and HbA1c decreased from 6.0 to 5.8 % (p=0.03). Mean BMI Z-score decreased from 2.56 to 2.53 (p=0.07) and BMI percent of the 95^th percentile decreased from 153.4% to 150.1% (P=0.006). Mean daily estimated carbohydrate consumption decreased from 251 to 147 grams (p=0.009) among participants who provided dietary history at baseline and at 3-month follow-up (n=12).

Conclusions:

Adoption of CGM wear in an adolescent population with prediabetes and obesity may be a helpful adjunct to therapy to improve HbA1c, support dietary changes, reduce rate of weight gain, and attenuate diabetes risk. Larger studies assessing longer term durability of effect are needed to fully assess efficacy of this intervention.

Funding Sources: Schultze Foundation