Continuous Glucose Monitoring: Imprecision Nutrition?
The market for precision nutrition advice is more than six billion dollars today and estimated to double by the end of this decade. Sales of continuous glucose monitoring devices are on their way to $20 billion within three years. But a new study this week in the American Journal of Clinical Nutrition suggests that the underpinnings of precision nutrition might suffer from imprecision. Aaron Hengist and colleagues write:
“A fundamental assumption of such precision dietary advice is that glucose responses to the same meal on repeated occasions within an individual are much less variable than their responses to different meals. However, this assumption has not been rigorously tested.”
A Simple Question
So they asked a very simple question. Can continuous glucose monitoring reliably predict how person’s blood glucose will respond to a particular meal? Not very reliably was the conclusion:
“Individual postprandial CGM responses to duplicate meals were highly variable in adults without diabetes. Personalized diet advice on the basis of CGM measurements requires more reliable methods involving aggregated repeated measurements.”
More Than Food
It turns out that many things beyond food alone are influencing our metabolic health. Kevin Hall was senior author on this study. With Eric Topol, he recently discussed these findings (and much more). Topol explained:
“We know that these spikes – the glucose regulation – is very much affected by so many things. Like stress, like sleep, like exercise. So it wouldn’t be at all surprising if you had the exact same food but you might not have the same response.”
Once again, food does not, by itself, tell the whole story of our metabolic health.
Hype for the Few Without Health for the Many
The hype of continuous glucose monitoring for people who want to finetune their lifestyle explains a lot. Health becomes a luxury in commerce. People with money and time to devote to this imprecision nutrition buy it despite the absence of a clear medical indication. Meanwhile, huge disparities exist in the access to this technology for patients with diabetes who truly need it.
A recent study showed that very few patients with diabetes get continuous glucose monitoring in primary care clinics for vulnerable communities. The number receiving it is only 1% for type 2 diabetes and 11% for type 1.
Such disparities and waste are simply grotesque.
Click here for the study in AJCN and here for a commentary to go with it. For further perspective, click here, here, and here.
Guardian 4 Glucose Sensor Needle, photograph by Marius Vassnes, licensed under CC BY-SA 4.0
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December 6, 2024
