Diet, Exercise, and Continuous Glucose Monitoring? Study Questions Sugar Monitoring for Weight Loss

Continuous Glucose Monitoring (CGM) offered little useful information for dietary choices among patients without diabetes, a researcher reported.  In a 23-person study of those who were non-diabetic obese or did not have obesity, wearing the CGM device for about a week produced no more useful clinical information than standard-of-care fasting glucose levels and homeostatic model assessment of insulin resistance (HOMA) scores, according to Mitchell Roslin, MD, of Lenox Hill Hospital in New York City.  “Our results were extremely interesting.  We saw no statistical difference between the obese and non-obese, non-diabetic groups in mean glucose, standard deviation, and MAGE [Mean Amplitude of Glycemic Excursion],” Roslin said at a poster presentation at the ObesityWeek virtual meeting.

MAGE is the “gold standard” for calculating the glycemic variability, while “HOMA and fasting insulin were significantly different and much higher among the [participants with obesity],” Roslin said.  He explained that people with obesity frequently have rising insulin levels, and a small rise in fasting glucose levels that bumps up the HOMA score; however, they are basically able to maintain normal glycemia until very late in the disease process, so “there was no discernable pattern” between the people with obesity and those without.

Yet CGM “has seen increased popularity in individuals with diabetes,” Roslin told MedPage Today.  “One of the reported outcomes is a change in eating behavior, a lowering of glycemic spikes, and associated weight loss.”

The majority of participants in the study were female (n=18), and all underwent fasting bloodwork that measured hemoglobin A1c (HbA1c), fasting insulin, and fasting glucose.  They then did blinded CGM with six (6) days of monitoring while keeping dietary logs.  Participants were not on any glucose or other metabolic therapies, according to Roslin’s group.

The authors reported the following for non-diabetic, non-obese participants and participants with obesity, respectively:

  • Mean age: 29.5 and 33.7;
  • Mean BMI: 23.5 and 39.4;
  • HbA1c: 5.1 and 5.58;
  • Fasting glucose: 97.5 and 104.1;
  • Fasting insulin: 6.9 and 22.7
  • Mean HOMA score: 1.3 and 5.9; and
  • Mean standard deviation (MAGE): 17.3 and 13.4.

“We believe that the use of CGM had potentially negligible impact on weight loss in non-diabetic individuals,” Roslin stated.  “Further investigation is required; however, premature efforts to market these devices to people who are overweight, but not diabetic, are probably not indicated.”

Caroline Apovian, MD, past-president of The Obesity Society, agreed, noting that “these are expensive devices, and it’s almost a miracle if we can get them covered for people who are diabetic much less for anybody else.  This is a pipe dream to try to market these devices to people who have obesity,” added Apovian, who is with the Center for Weight Management and Wellness at Brigham and Women’s Hospital/Harvard School of Medicine in Boston.

Apovian, who was not involved in the current study, pointed out people do not necessarily need a CGM device to tell them when they have consumed a high-sugar food.  “I don’t think we have to convince people of that.  I can demonstrate that using other methods other than with a CGM,” she said.

REFERENCE:  MedPage Today; 06 NOV 2021; Ed Susman

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