Continuous glucose monitors: how useful are they?

Tracking steps and sleeping is old school. The latest trend in health tracking? Glucose. Videos talking about using continuous glucose monitors (aka CGM) are on TikTok, and ads for the latest health gadgets are probably following you online.

Many people with diabetes (incl Nick Jonas, who appeared in a Super Bowl ad for Dexcom’s CGM), more common Joes and Janes, and even elite athletes strap continuous glucose monitors on their arms to detail their levels throughout the day.

If you see a plastic circle on the upper back of someone’s arm, that’s a CGM. This is the easiest way to track glucose. A blood sugar meter or glucometer requires a small sample of blood to be tested—usually through a finger prick.

The hope is that CGMs will help people learn the best foods to eat and the right order to eat them to encourage weight loss, increase energy, and do other things. victory of health.

Understanding glucose levels

Blood glucose, which your body creates from food during the digestion process, provides energy. Insulin carries it through the blood system to the cells, giving you the ability to get up-and-play tennis, go to the gym and, or finish work. Your body immediately uses some and leaves the rest of the cells for later use.

Dr. Liz Applegate, distinguished senior lecturer and director of sports nutrition emerita at the University of California Davis, compared the body’s blood glucose delivery system to the hallways of a multi-classroom kindergarten building. “Think of your body as a busy school. All your blood vessels are hallways and cells are classrooms. Insulin is a monitor in the hallway and students have blood glucose,” he said. “So when there are more glucose students from what we eat, the insulin tells the glucose where to go. It knocks on the doors of the classrooms. If the cell receptor works well, the door opens and the glucose comes in. So that is the usual situation.

If it doesn’t work, that’s “hundreds of little kids running around unattended and writing on the walls. That’s glucose that damages the epithelial lining of the blood vessels” and creates health problems.

When blood glucose drops low in diabetics, they may become hypoglycemic and may begin to feel shaky, dizzy, faint, or very confused. Over time, uncontrolled diabetes can lead to heart or kidney disease and serious vision and hearing issues, as well as foot problems. So, yes, glucose monitoring is a must for this population—as well as those with a family history of type 2 diabetes or other pre-diabetes symptoms.

But for people without diabetes, fluctuations in blood sugar not usually dangerous. They are, for the most part, just part of everyday life as people eat (or skip meals), exercise, and drink alcohol.

“There are a lot of factors that go into it,” Applegate said. And blood glucose levels are balanced as daily activity changes.

How continuous glucose monitoring works

CGMS does not measure blood glucose levels. Instead, they measure glucose levels in the interstitial fluid, or the fluid that surrounds your cells. Glucose normally flows from the blood vessels into the cells, so the level of glucose in the interstitial fluid is usually slightly lower than the level of glucose in the blood.

Most CGMs include a housing that contains a data transmitter and a minimally invasive filament sensor that is inserted under the skin. (Earlier versions—some of which are still on the market—used a needle instead of a filament.) The filament, coated with glucose-sensing enzymes such as glucose oxidase, degrades over time and must be replaced every seven to 14 day, depending on the brand. The housing is held in place with an adhesive on the back of the wearer’s arm. The data transmitter sends the information collected through the filament to a monitor or an app on the user’s phone and, usually, whatever service the person uses to monitor their numbers. For patients with diabetes, this may include a clinic or doctor’s office.

For non-diabetic CGM users, the numbers are where things get tricky. Blood sugar is a constantly changing numberdepending on what you eat and drink, sleep, exercise, stress, hormones, medications, time of day, etc. Diabetics know what to watch out for but, for non-diabetics, the meaning behind the constant number shift can be confusing.

CGM technology

CGMs, whether for diabetics or people concerned about blood sugar, are not a cheap technology. Insurance or Medicare usually pays for a CGM for people with diabetes. But today’s technology is also being developed for health-driven companies, rather than those sitting on the purely medical side of the glucose line.

Companies that offer CGM to the general public—usually through direct-to-consumer marketing—include NutriSense, signsand Data. Their products are often bundled with personalized nutrition advice based on the customer’s criteria.

At NutriSense, they say it is a holistic approach to health that prevents future health problems from developing. “We spend more money per person every year on people trying to help them with their health, and more than any other country in the world. People keep getting sicker and sicker,” said Dan Zavoropny, co- founder and COO of NutriSense, a company that provides everyday people with CGMs and offers personalized nutrition counseling based on the results.

He founded NutriSense to try and “prevent disease and give people information in advance versus trying to manage things when it’s too late.”

The program, which has been on the market for more than three years, costs $250 for one month of monitoring, and provides access to a dietitian who “will help you understand what you see, look at your goal, and then tell you. hey, I think these are the most important changes you can make to improve your health“said Carlee Hayes, senior nutrition manager at Nutrisense.

While the explanation seems promising, there isn’t much research to support glucose monitoring for the average person. “Historically, research has lagged behind technology. Continuous glucose monitoring is no exception to that rule,” Hayes said.

However, he added, there are “many research studies now that use this technology in individuals without diabetes, but it’s really in the preliminary phase.” NutriSense is doing its own clinical trials and Zavoropny says “we’re seeing some really good results.” He could not share details until the studies are published.

The cost of CGMs

Because of that $250 per month monitoring cost, CGMs are out of reach for many consumers. The biggest cost comes from the hardware, which needs to be replaced every two weeks because the sensors wear out, but Zavoropny says that “when it became more scalable and the hardware manufacturers started to lower the prices and there is more competition in the market,” the lower the price.

And, says Zavoropny, “theoretically insurance companies will start covering it over time [and] reduce costs in the future.” He also said that people don’t need to wear the devices all year round. They say some customers use a CGM a month to get baseline measurements and a first round of advice from their dietitians. (One month requires a hardware swap-out so the user can get a new sensor.)

Since these are not diabetic patients, daily monitoring is not necessary. They can create a plan based on a month’s worth of data. Then people come back for another round of using the device every 12 to 18 months to adjust to where their life and diet is at that point. Customers only pay when devices and services are actively used.

Should you use a continuous glucose monitor?

When it comes to using a CGM for general health, no physical harm comes from just using the devices.

Although Applegate doesn’t recommend the units for the average person, he thinks there are some good use cases for elite athletes who want to get an edge before a big event. “But do you always need it?” he asked. “I look at it as TMI … especially for these average Joes who do it because it’s a fad and then they put it to the side.”

His recommendation? He suggests focusing on “gross measurements” like dropping 10 pounds or cutting three minutes off your 10K.

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