Validity of continuous glucose monitoring for categorizing glycemic responses to diet: implications for use in personalized nutrition

Feb 8, 2022The American journal of clinical nutrition

How well continuous glucose monitors classify blood sugar responses to diet and what this means for personalized nutrition

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Abstract

The coefficient of variation (CV) for glycemic responses measured by the same brand of continuous glucose monitors (CGMs) was 3.7% for standardized meals.

The CV for glycemic responses between different brands of CGMs was found to be 12.5% for standardized meals.
For ad libitum meals, the CV for intrabrand device comparisons was 4.1%, while interbrand comparisons had a CV of 16.6%.
Meal rankings based on glycemic responses showed high agreement between paired CGM devices, with Kendall τ rank correlation values of 0.9 for intrabrand and 0.7 for interbrand comparisons.
Strong concordance was observed for time in range, with an intrabrand device CV of 4.8% and an interbrand device CV of 3.2%.

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BACKGROUND: Continuous glucose monitor (CGM) devices enable characterization of individuals' glycemic variation. However, there are concerns about their reliability for categorizing glycemic responses to foods that would limit their potential application in personalized nutrition recommendations.

OBJECTIVES: We aimed to evaluate the concordance of 2 simultaneously worn CGM devices in measuring postprandial glycemic responses.

METHODS: Within ZOE PREDICT (Personalised Responses to Dietary Composition Trial) 1, 394 participants wore 2 CGM devices simultaneously [n = 360 participants with 2 Abbott Freestyle Libre Pro (FSL) devices; n = 34 participants with both FSL and Dexcom G6] for ≤14 d while consuming standardized (n = 4457) and ad libitum (n = 5738) meals. We examined the CV and correlation of the incremental area under the glucose curve at 2 h (glucoseiAUC0-2 h). Within-subject meal ranking was assessed using Kendall τ rank correlation. Concordance between paired devices in time in range according to the American Diabetes Association cutoffs (TIRADA) and glucose variability (glucose CV) was also investigated.

RESULTS: The CV of glucoseiAUC0-2 h for standardized meals was 3.7% (IQR: 1.7%-7.1%) for intrabrand device and 12.5% (IQR: 5.1%-24.8%) for interbrand device comparisons. Similar estimates were observed for ad libitum meals, with intrabrand and interbrand device CVs of glucoseiAUC0-2 h of 4.1% (IQR: 1.8%-7.1%) and 16.6% (IQR: 5.5%-30.7%), respectively. Kendall τ rank correlation showed glucoseiAUC0-2h-derived meal rankings were agreeable between paired CGM devices (intrabrand: 0.9; IQR: 0.8-0.9; interbrand: 0.7; IQR: 0.5-0.8). Paired CGMs also showed strong concordance for TIRADA with a intrabrand device CV of 4.8% (IQR: 1.9%-9.8%) and an interbrand device CV of 3.2% (IQR: 1.1%-6.2%).

CONCLUSIONS: Our data demonstrate strong concordance of CGM devices in monitoring glycemic responses and suggest their potential use in personalized nutrition.This trial was registered at clinicaltrials.gov as NCT03479866.

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Validity of continuous glucose monitoring for categorizing glycemic responses to diet: implications for use in personalized nutrition

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