December 12, 2023 – Wearable technology has made a critical difference for consumers. From rings and watches to bracelets, patches and clothing, information that when required lots of confusing calculations is now available anytime, anywhere with the flick of a wrist or a look at a smartphone.
Continuous glucose monitors — devices that help individuals with diabetes avoid dangerous and extreme changes in blood sugar levels — are amongst the most recent wearables to achieve attention. Approved by the FDA to be used in diabetes, tens of millions of consumers are jumping on the CGM bandwagon with the support of social media influencers and the promise of improved athletic performance, weight reduction and metabolic health.
Before you join the masses and buy one in all these devices, bear in mind that diabetes experts agree that CGMs are intended for the patron marketplace for individuals who don't have diabetes but still need to try to manage their blood sugar monitor, are usually not yet quite ready for the patron market.
“If you look at history, there have been many cases where a large number of people followed something that ended up being incorrect,” Dr. Tamara Oser, director of the first care diabetes laboratory on the University of Colorado Aurora Anschutz School of Medicine.
Despite their increasing popularity, Oser said: “We have to be clear that we don't yet have really convincing evidence that they will lead to a change in outcomes,” she said.
ups and downs
Blood sugar spikes after meals are a standard phenomenon.
“They go up, your body responds within 15 to 30 minutes and then it gradually goes down. This is a normal process,” said Dr. Marc Kai, an internist at Mercy Medical Center in Baltimore. “For someone with diabetes, the number may be higher, last longer, and may take longer to return to normal; That’s why we use these monitors: so we can see what’s happening and when.”
The challenge arises when a one who doesn’t have diabetes takes this information and reinterprets it to suit an often incomplete narrative.
“A lot of companies that sell CGMs and apps are taking data from their customers and making generalizations, and that's just inappropriate,” says Danielle Omar, a registered dietitian and nutritionist based in Northern Virginia. One example is eating oatmeal, which one social media influencer compares to “being chased by a Siberian tiger.”
Some people saw data that showed their blood sugar spiked after eating oatmeal. “But that’s just how your body works; You just ate a carb,” she said.
“There are so many factors,” Omar said. “What was in the oatmeal, what kind of oatmeal was it? “Was it quick oats, steel cut or overnight oats? What was in it? Was it sugar or jelly? A banana? Oat milk? You know, there are so many things that could have been the real reason why her blood sugar went up.”
Omar's concerns are usually not unfounded. David Lam, MD, an endocrinologist and associate professor on the Icahn School of Medicine at Mount Sinai in New York City, said, “It's natural to go on a glucose trip.” Although CGMs can probably educate people about how their “Baseline might look like, and provide positive reinforcement to reduce calorie intake, I don’t know if they offer any benefit compared to the advice of a registered dietitian.”
What CGMs do and don't do
Continuous glucose monitors were first developed within the Nineties to assist patients with type 1 diabetes and are actually also utilized in certain type 2 diabetes patients. Researchers are also studying the advantages for other groups, including individuals with prediabetes and elite athletes. However, these devices are usually not without limitations and are usually not suitable for everybody.
Lam says he uses the monitors on his patients with diabetes, but not on a big scale.
“It’s an individual treatment decision,” he says. “Just because the technology exists and is FDA-approved for certain medical conditions does not mean everyone can use it. When I prescribe a CGM to my patients, it is always accompanied by a discussion about what it can offer, what it does, what its limitations are, and how I think it might help in their care.”
What exactly do these devices do?
“CGMs provide an estimate of a person's blood sugar level at that moment,” Lam said, noting that the measurement may also help an individual avoid dangerous and sometimes life-threatening blood sugar drops or sustained and equally dangerous peaks. This differs from more traditional measurements reminiscent of the A1c blood test, which measures average blood sugar levels over a three-month period.
Unlike a finger prick, which measures sugar concentration In Blood: “CGMs measure the concentration of sugar in the tissues just outside the bloodstream – the “interstitial” fluid and condition that exists within the tissue,” Kai said. “Basic science says it will be about the same.”
He said that if you’ve diabetes or insulin problems, blood sugar spikes that sometimes occur after eating are inclined to last more and take longer to return to normal. Knowing this information, called “period,” may also help influence behavior (e.g., avoiding certain desserts) and guide treatments or changes in weight loss plan and lifestyle.
What you want to know
There is little doubt that there’ll likely be a spot for continuous glucose monitors within the non-diabetes consumer marketplace for the foreseeable future. Fernando Ovalle, MD, endocrinologist, professor and director of the Diabetes & Endocrine Clinical Research Unit on the University of Alabama-Birmingham, said not less than 1 / 4 of the population is vulnerable to developing diabetes, with 20% of those potentially developing it slowly over the course of their lives. “The question is, how many of these people can you help avoid or delay it, or if not, at least improve it?”
Ovalle said more research is required in order that “we can know beyond the glucose tolerance test what is truly normal and what is truly abnormal.”
At least for now, the technology needs to enhance. Oser said that not only do the readings differ between CGM devices, but also they are less accurate at lower levels than at normal or high levels.
There can be a risk of “false lows.”
“I have a patient without diabetes or prediabetes whose CGM showed low blood sugar. She was so distressed that she went to the emergency room and had a false low,” Osler said. Things like incorrect placement on the body, dehydration, and even skin trauma at the location site may affect accuracy.
Another essential aspect is that it's not only food that may influence blood sugar levels. “Glucose is really a window into physiology,” Lam said. “Besides the obvious, exercise, various stressors (including illness), hormones that help the body fight infection, sleep, medications, all of these things can increase insulin resistance and glucose levels.”
One of the potential dangers of a healthy person using a continuous glucose monitor is information overload, Kai said.
“Blood sugar levels vary from person to person, so people will look for numbers and worry, even though the response is completely normal for their physiology, their own personal body, their own personal metabolism,” he said.
If you're still excited by trying a continuous glucose monitor, not less than seek the advice of your doctor or a nutritionist who can allow you to understand what the numbers are telling you and the way to use them in a way that works for you personal health is smart.