Continuous Blood Glucose Monitoring Key Points:
- Continuous Blood Glucose Monitoring (CGM) is a transformative technology that has significantly improved diabetes management, its necessity for healthy individuals, particularly those on low-carbohydrate diets, is not well established.
- There is not conclusive evidence that CGM will benefit weight loss in non-diabetic individuals.
- There is not conclusive evidence that “lower blood glucose” is better for health if you are already in the normal ranges.
- Spikes in glucose is not a health issue for healthy adults if they return to normal values in a appropriate time.
What Is Continuous Blood Glucose Monitoring (CGM)?
Are you struggling with weight loss and looking for a new approach that could help you shed those pounds? Well, have you ever considered continuous glucose monitoring (CGM)? Continuous blood glucose monitoring (CGM) is FDA approved and has revolutionized the management of diabetes, providing real-time and predictive glycemic data that has proven invaluable for individuals with type 1 and type 2 diabetes. (Battelino et al., 2019; Rodbard, 2016) However, the necessity of CGM for healthy individuals, particularly those on low-carbohydrate diets, is a topic of ongoing debate.
Some studies show that CGM may be useful for those focused on nutrition and weight loss. For example, a pilot study used CGM to motivate physical activity in overweight and obese adults. The study found that access to CGM data effectively increased physical activity levels in this population. (Liao et al., 2020) The necessity of wearing CGM devices for healthy individuals on low-carb diets is questionable and not recommended by the American Diabetes Association.
In this blog, we will dive deep into the world of CGM and explore how it can help you manage your blood glucose levels and may assist in weight loss. We’ll discuss what exactly continuous blood glucose monitoring is and its benefits. If you’re curious about the link between CGM and weight loss or how it relates to low-carb diets, this blog covers you. Get ready to discover a new tool that may revolutionize your health and well-being!
What is continuous blood glucose monitoring?
CGM technology allows individuals to track their glucose levels in real time throughout the day. This is a better alternative than finger sticks. It involves wearing a biosensor that measures glucose levels (i.e., high blood sugar/ low blood sugar) in the interstitial fluid. It is then transmitted to a handheld monitor or cell phone smartphone app. This gives users detailed information about the amount of glucose levels, fluctuations, and other glucose-specific metrics.
Benefits of continuous blood glucose monitoring
There are several benefits of CGM, some of the benefits:
1. Improved glycemic control: CGM provides real-time glucose readings, which can help individuals with diabetes make more informed decisions about their diet, exercise, and medication use. It can detect if glucose is dropping or if there are spikes. The CGM results can lead to improved glycemic control and reduced risk of complications associated with high or low blood glucose levels. A healthcare provider can make better decisions regarding health care treatment options.
2. May Aid to weight loss: CGM may be used as a real-time feedback device or motivational tool for improving behavior, leading to improvements in body weight, body mass index (BMI), and other metabolic markers. However, CGM is not approved for weight loss. There is limited evidence regarding the approval and effectiveness of CGM specifically for weight loss purposes in healthy individuals.
3. Improved mental health: CGM can help individuals with diabetes better understand the impact of their lifestyle habits on their glucose levels, which can lead to improved mental health and quality of life.
4. Behavior modification: CGM can be used as a behavior modification tool to encourage physical activity, modify food choices, and improve overall lifestyle habits.
5. Better management of hypoglycemia: CGM can help individuals with diabetes better manage hypoglycemia by providing real-time alerts when glucose levels are low.
6. Improved diabetes management: CGM can help individuals with diabetes better manage their condition by providing more detailed information about their glucose levels, leading to more personalized treatment plans and improved outcomes.
Downfalls of continuous monitoring blood glucose
CGM may have some potential drawbacks or challenges. Here are a few possible negative effects or considerations associated with CGM:
1. Discomfort or skin irritation: Wearing a CGM device may cause discomfort or skin irritation at the insertion site. Some individuals may be more sensitive to the adhesive or experience allergic reactions. Proper skin care and rotation of insertion sites can help minimize these issues.
2. Cost: CGM devices and sensors can be expensive, and the cost may not be fully covered by insurance for everyone. Affordability and insurance coverage can be a barrier for some individuals in accessing and using CGM.
3. Technical issues: CGM devices rely on accurate sensor readings and wireless data transmission. Technical issues such as sensor errors, signal loss, or device malfunctions can occur, leading to inaccurate or interrupted glucose readings.
4. User burden: Continuous monitoring of glucose levels requires active user participation and engagement. Some individuals may need help with constant monitoring and data interpretation. Some studies have reported negative psychological effects, such as increased anxiety and depressive symptoms, associated with CGM use .
5. False alarms or alerts: CGM devices may generate false alarms or alerts, leading to unnecessary interventions or anxiety. Users must understand the device’s limitations and work with healthcare professionals to set appropriate alert thresholds.
Who should use continuous glucose monitoring levels?
Continuous blood glucose monitoring is recommended for individuals with diabetes or prediabetes who want to monitor their blood sugar levels closely. It can also be helpful for those who struggle with traditional monitoring methods and individuals aiming to improve their overall health and weight management.
Glucose variability is a significant aspect of diabetes management. CGM has been proven beneficial for individuals with type 1 diabetes and type 2 diabetes in managing blood glucose levels and reducing the risk of hypoglycemia and hyperglycemia. (Duckworth et al., 2022) It has been identified as a predictor of hypoglycemia and is related to intensive care unit mortality.
A recent trend in the fitness community is that lower glucose throughout the day is better. A 2011study analyzed the association of HbA1C (i.e., a marker of blood glucose control) with death rates in men and women. They analyzed HbA1C with ranges from <4.5% to > 6.5%. A normal HbA1C is below 5.7%. Interestingly, those with lower HbA1C had the same death rates as those with 5.5%. After 5.5% death rates started to increases after 5.5%. The study suggests that lower HbA1C may not be better for reducing the risk of death. (Pfister et al. 2011)
Other potential relations are between glucose variability, oxidative stress, and microvascular and macrovascular complications of diabetes. (Giménez et al., 2010; Hoffman et al., 2016; Yamazaki et al., 2014) However, there is little consensus on the importance of glucose variability as an independent risk factor or a causal factor in developing these complications.
Monophasic vs. Diphasic Glucose Curve
A monophasic glucose curve is a curve that shows a single peak in glucose levels after a meal, whereas a biphasic curve shows two peaks, one around 30-60 minutes after a meal and another 90-120 minutes after the meal.
Recent research has demonstrated that the incidence of metabolic dysfunction is higher in individuals with monophasic glucose curves (i.e., a large increase in glucose), with these individuals having lower insulin sensitivity, lower beta-cell function, and a higher prevalence of Metabolic Syndrome and prediabetes.(de Andrade Mesquita et al., 2018) The development of a monophasic glucose curve may be an early sign of β-cell function, even in asymptomatic individuals. A Danish study found subjects with high 30 minute glucose, but low 2-hour glucose had an increased risk of developing diabetes and early death.(Hulman et al. 2017)
CGM in Healthy Adults
CGM systems, originally developed for diabetes patients, are increasingly used by healthy adults. (Jarvis et al., 2023) They can help examine the impact of their diet, exercise habits, and other behaviors on their glucose response. It has been suggested to aid in weight loss, optimize mental health, suppress hunger and food cravings, improve sleep, and avoid glycemic fluctuations that could lead to chronic diseases like cardiovascular disease.
CGM and Weight Loss
A diet consisting of a greater proportion of calories from protein and fat with a reduction in carbohydrates has been shown to facilitate steady glucose levels. Protein has a slower rate of digestion when compared to carbohydrates; consequently, a diet rich in protein can support steadier glucose absorption and reduce post-meal glucose levels. (Franz, 1997)
Some evidence suggests that CGM may provide useful information for weight loss. A study conducted on overweight young adults showed that individuals with access to continuous glucose monitoring (CGM) data were able to improve their body weight, Body Mass Index (BMI), fat mass, and other metabolic markers such as fasting plasma glucose, HbA1c, and cholesterol levels more than individuals not using CGM. (Chekima et al., 2022)
CGM Studies
A small study surveyed 40 CGM users with prediabetes or diabetes mellitus (DM). 90% of these felt that CGM use contributed to a healthier lifestyle. 47% of CGM users reported being more likely to walk or undertake physical activity if they saw a rise in glucose levels. 87% of CGM users felt they modified their food choices based on CGM use. (Ehrhardt & Al Zaghal, 2020)
In a randomized controlled trial, Martens et al. [2021] studied the impact of CGM use amongst individuals with type II DM receiving basal insulin. CGM use was associated with a significantly greater decrease in HbA1c levels over eight months than blood glucose meter use, further supporting the notion that CGM use leads to positive behavior change.(Martens et al., 2021)
There is no reason to believe that CGM only functions as a behavior modification tool in individuals with DM, and it will be interesting to see if these findings can be duplicated in CGM users without DM. This suggests that CGM can be used as a real-time feedback device or motivational tool for improving behavior and aiding in weight loss.
CGM devices have been validated for use in clinical settings in patients with diabetes. However, their accuracy in measuring blood glucose concentrations in healthy individuals has not been extensively studied. While CGM devices may provide insights into glucose concentrations in healthy participants, their accuracy compared to laboratory measurements is still a subject of investigation (Kontou et al., 2021). Therefore, relying solely on CGM devices for blood glucose monitoring in healthy individuals may not provide accurate results.
CGM and Low Carb Diets
Additionally, a study investigated the relationship between the size of the postprandial dip in glucose and hunger levels in individuals with overweight or obesity. The study found that the size of the postprandial dip in glucose was a significant predictor of hunger and subsequent calorie intake, suggesting that the postprandial dip in glucose may play a role in regulating appetite and food intake. (Breymeyer et al., 2016)
Another study investigated the relationship between postprandial glycaemic dips and appetite and energy intake in healthy individuals. The study found that larger postprandial glycaemic dips were associated with increased hunger and energy intake, suggesting that the postprandial dip in glucose may be a physiological signal for hunger. (Wyatt et al., 2021)
Page et al. (2011) found that the size of the postprandial dip in glucose following a meal predicts the degree of hunger and the subsequent number of calories consumed. This suggests that a larger dip in glucose is associated with increased hunger and higher calorie intake. (Page et al., 2011)
It’s important to note that the specific relationship between the postprandial dip in glucose and hunger levels may vary depending on individual factors such as meal composition, timing, and individual response.
While the use of CGM in healthy adults is increasing, its necessity for those on low-carbohydrate diets is questionable. The primary purpose of a low carbohydrate diet is to limit the intake of carbohydrates, which in turn reduces the body’s need to regulate high levels of blood glucose. Therefore, the need for continuous monitoring of blood glucose levels in healthy individuals on such diets may not be as critical as in individuals with diabetes.
Conclusion
In conclusion, while CGM is a transformative technology that has significantly improved diabetes management, its necessity for healthy individuals, particularly those on low-carbohydrate diets, is not well established. Further research is needed to fully understand the potential benefits and drawbacks of CGM use in this population. However, current evidence shows that continuous blood glucose monitoring is unnecessary for healthy adults on low-carbohydrate diets.
References
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Breymeyer, K. L., Lampe, J. W., McGregor, B. A., & Neuhouser, M. L. (2016). Subjective mood and energy levels of healthy weight and overweight/obese healthy adults on high-and low-glycemic load experimental diets. Appetite, 107, 253-259. https://doi.org/10.1016/j.appet.2016.08.008
Chekima, K., Noor, M. I., Ooi, Y. B. H., Yan, S. W., Jaweed, M., & Chekima, B. (2022). Utilizing a Real-Time Continuous Glucose Monitor as Part of a Low Glycaemic Index and Load Diet and Determining Its Effect on Improving Dietary Intake, Body Composition and Metabolic Parameters of Overweight and Obese Young Adults: A Randomised Controlled Trial. Foods, 11(12). https://doi.org/10.3390/foods11121754
de Andrade Mesquita, L., Pavan Antoniolli, L., Cittolin-Santos, G. F., & Gerchman, F. (2018). Distinct metabolic profile according to the shape of the oral glucose tolerance test curve is related to whole glucose excursion: a cross-sectional study. BMC Endocr Disord, 18(1), 56. https://doi.org/10.1186/s12902-018-0286-7
Duckworth, C., Guy, M. J., Kumaran, A., O’Kane, A. A., Ayobi, A., Chapman, A., & Boniface, M. (2022). Explainable Machine Learning for Real-Time Hypoglycaemia and Hyperglycaemia Prediction and Personalised Control Recommendations. https://doi.org/10.1101/2022.03.23.22272701
Ehrhardt, N., & Al Zaghal, E. (2020). Continuous Glucose Monitoring As a Behavior Modification Tool. Clin Diabetes, 38(2), 126-131. https://doi.org/10.2337/cd19-0037
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Jarvis, P. R. E., Cardin, J. L., Nisevich-Bede, P. M., & McCarter, J. P. (2023). Continuous glucose monitoring in a healthy population: understanding the postprandial glycemic response in individuals without diabetes mellitus. Metabolism, 155640. https://doi.org/10.1016/j.metabol.2023.155640
Liao, Y., Basen-Engquist, K. M., Urbauer, D. L., Bevers, T. B., Hawk, E., & Schembre, S. M. (2020). Using Continuous Glucose Monitoring to Motivate Physical Activity in Overweight and Obese Adults: A Pilot Study. Cancer Epidemiol Biomarkers Prev, 29(4), 761-768. https://doi.org/10.1158/1055-9965.Epi-19-0906
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References
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