Continuous Glucose Monitoring in Adolescents With Obesity: Monitoring of Glucose Profiles, Glycemic Excursions, and Adherence to Time Restricted Eating Programs

Abstract

Background: Randomized controlled trials of time restricted eating (TRE) in adults have demonstrated improvements in glucose variability as captured by continuous glucose monitors (CGM). However, little is known about the feasibility of CGM use in TRE interventions in adolescents, or the expected changes in glycemic profiles in response to changes in meal-timing. As part of a pilot trial of TRE in adolescents with obesity, this study aimed to 1) assess the feasibility of CGM use, 2) describe baseline glycemic profiles in adolescents with obesity, without diabetes, and 3) compare the difference between glycemic profiles in groups practicing TRE versus control.

Methods: This study leverages data from a 12-week pilot trial (ClinicalTrials.gov Identifier: NCT03954223) of late TRE in adolescents with obesity compared to a prolonged eating window. Feasibility of CGM use was assessed by monitoring 1) the percent wear time of the CGM and 2) responses to satisfaction questionnaires. A computation of summary measures of all glycemic data prior to randomization was done using EasyGV and R. Repeat measures analysis was conducted to assess the change in glycemic variability over time between groups. Review of CGM tracings during periods of 24-hour dietary recall was utilized to describe glycemic excursions.

Results: Fifty participants were enrolled in the study and 43 had CGM and dietary recall data available (16.4 + 1.3 years, 64% female, 64% Hispanic, 74% public insurance). There was high adherence to daily CGM wear (96.4%) without negative impacts on daily functioning. There was no significant change in the glycemic variability as measured by standard deviation, mean amplitude glycemic excursion, and glucose area under the curve over the study period between groups.

Conclusions: CGM use appears to be a feasible and acceptable tool to monitor glycemic profiles in adolescents with obesity and may be a helpful strategy to confirm TRE dosage by capturing glycemic excursions compared to self-reported meal timing. There was no effect of TRE on glucose profiles in this study. Further research is needed to investigate how TRE impacts glycemic variability in this age group and to explore if timing of eating window effects these findings.

Keywords: adherence - compliance - persistence; adolescent; continuous glucose monitor (CGM); glycemic excursion; glycemic profile; obesity; time restricted eating.

Figure 1

Continous glucose monitor satisfaction survey result. (A) Helps me feel more satisfied with my weight management. (B) Gives me information about my glucose that is useful. (C) Helps me identify how food and activity affect me. (D) Makes me feel more frustrated about my weight.

Figure 2

Fasting and non-fasting glycemic excursion events observed for each participant at baseline, week 4 and 12. Glycemic excursion is defined as the difference between the minimum and maximum glucose levels observed during the period of widest glycemic variability (A) displays the average glycemic excursion observed for each participant during the run-in period at baseline. (B, C) display glycemic excursion observed during fasting and non-fasting on days that 24-hour dietary recall was obtained. There were 105 unique glycemic excursion events extracted from 39 participant’s CGM data.

Figure 3

Correlation between mean fasting excursion and weight change over time by intervention arm (A–C) and combined (D). Fasting excursion denoted by red dotted line. Weight change denoted by solid blue line.