Introduction: Kiritimati is a remote Pacific Island with a high rate of type 2 diabetes (∼30%), potentially related to high sugar consumption starting early in life. This pilot study aimed to determine the effects of a short-term sugar-reduction intervention in Kiritimati teenagers.

Methods: The two high schools on the island were randomly assigned to a 7-day sugar-reduction intervention group (n=46) or control group (n=32). The intervention consisted of installation of a water filter at the school, distribution of individual water bottles, and a sugar-reduction presentation by a registered dietitian. 24-hour diet recalls were conducted at baseline and follow-up. Continuous blood glucose monitors (CGMs; FreeStyle Libre Pro) were used to assess 94 interstitial glucose measures over 14 days. A difference-in-differences analysis was used to address baseline differences between the schools. Data are presented as mean ± SD.

Results: At baseline, overweight/obesity prevalence was 50% (control group) vs. 43% (intervention group); age 17.2 ± 1.6 vs. 16.8 ± 1.8 years; mean blood glucose 88.3 ± 7.8 vs. 89.3 ± 31.5 mg/dL; added sugar consumption 122 ± 87 vs. 139 ± 77g/day; and %kcal from added sugars 18.3 ± 10.4 vs. 20.1 ± 9.5%. After the intervention, added sugar consumption decreased to 39 ± 47g (7.3 ± 8.3%kcal) in the intervention group without changing (133 ± 116g/19.2 ± 9.7%kcal) in the control group (time x group interaction p=0.003). However, there were no significant effects on any of the CGM measures.

Conclusion: Despite high rates of type 2 diabetes on the island as a whole, blood glucose was normal in high-school teenagers, and was unaffected by the intervention. However, added sugar consumption was high (∼20 %kcal), which was greatly improved after the intervention (∼7 %kcal). This study suggests that a simple sugar-reduction intervention could improve diet quality in teenagers on Pacific Islands with high rates of type 2 diabetes such as Kiritimati.


J. Plows: None. C. Rios: None. P. Berger: None. R.B. Jones: None. T.L. Alderete: None. S. Steinberg: None. T. Bangao: None. E. Beale: None. M.I. Goran: Advisory Panel; Self; Yumi. Other Relationship; Self; Penguin Random House.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at