The evidence is convergent. Multiple independent sources reach the same conclusion, the underlying mechanism is well-characterized, and even the field's most cautious voices treat it as worth doing.
So it's not representative of what is existing in real food. So I would think in an ideal world the research that needs to be done is wearing people wearing a CGM, monitoring these postprandial responses to a variety of real foods.
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I would argue that you probably only need to use it for two to four weeks Max um and that's because most people eat the same thing again and again and again and again and how you respond to individual Foods is fairly uh repeatable
in many ways that's what the C GM has kind of allowed us to do the C GM without the insulin is at least allowing us to see the glycemic response to the real-world challenge of this
I think that to have CGM data on a patient and a lot of our patients don't want to wear a CGM although I think that's gonna change with the Dexcom g6 so I I started my career using the g5 now you know the g5 I love but I could understand why if you didn't actually have type you know diabetes you know that was a bit of a bit of a stretch because you know you're inserting this needle and it was you know it was just a bit more involved plus it required calibration twice a day then a company called Libra got bought by Abbott and they had a no calibration one that got quite popular but we've used it a lot and I find it to be categorically useless it's so inaccurate and you can't force a calibration also it doesn't have you can't it doesn't interact with your phone so it's just like useless in that regard so do those both use a needle in the same place the liebre is typically inserted on the back of the arm and it's a it was at the time a much easier way to insert the new Dexcom g6 which I don't think is out yet but I've been lucky enough to have a prototype for awhile the the g6 inserts the same way as the Libra it's it's it's plug-and-play it's trivial it requires you don't even feel it going in it's a much smaller needle goes in much faster so you don't you're not you're not the one responsible for the velocity at which it goes into you and it also doesn't require calibration though you can still spot check mine once a day I've been blown away by the accuracy and its interface with the phone is second to none so it's just it's just it's it's amazing I think in reality if I had a month of CGM data with accurate food information that's probably more valuable to me than the OG TT even though I'm giving up insulin meaning I'm not gonna get to see the insulin but I also get to see you know a month of someone in their real environment eating the likelihood that I'll miss in that entire month because they're gonna probably eat something really bad and if I can see how they're reacting to that you know that's probably pretty good but look it's still not a complete substitute for that hyperinsulinemia so it's it's it's it's not perfect but I also find that the CGM for me is one of the its along with the my sleep ring it's the stickiest device I've ever used whereas any other wearable I've ever used it's like after two weeks I don't want to wear it anymore because I've already learned what I need to learn like I know how many steps I take why do I care so I've got this whole theory around what wearables matter you know it's like are you measuring something that matters I don't want a wearable that's telling me something that's irrelevant clinically is the device actually measuring what it claims to be measuring is it am I able to get feedback in real time because that was the problem with the Libra is you couldn't get real-time feedback you know unless you were gonna carry around this other device it came with whereas with the Dexcom you're getting real-time feedback and so as real time as exists meaning when you eat something you don't see your glucose move at that moment but I certainly know after a meal how that meal or the amount of exercise with the amount of stress I was under impacted things and then do I have an ability to sort of fix it do I have any control over the outcome so you know CGM for me has continues to this day even though we're probably three years into doing this stuff I mean it's it's hard for me to imagine a day when I'm not gonna want to know my glucose every minute of every day how much of those two things particularly the CGM maybe that the ring - because you're talking about a lot of things probably sleep extras is diet etc are these things almost like accountability coaches that the idea that you get this real-time feedback of the stuff that you're eating if you're gonna eat some crap whatever it is you know that it's gonna show up do you think that there's any of that aspect to those things for me there definitely is especially on the glucose ring I had a buddy stay at here last night and like after we went out and got dinner and then on the way home he's like uh do you mind if we stop at the store I want to get some stuff for the morning and he you know got a little box or granola and so you know this morning get up to our thing and he eats some of the granola but left the box and as he left I'm like goddamn it like I love granola but like it's candy it's not a it's nice like you know so I just threw it out immediately like open the thing through the granola out and make sure I wouldn't eat it and in part I think it's that
i favor ogtt which is short for original gangster time trial that's right yeah okay perfect i think it might be oral glucose tolerance test with insulin measurements and also wearing a cgm to get a better sense of glucose homeostasis
Post-meal glucose spikes in non-diabetics drive long-term cardiometabolic disease independently of HbA1c.
Wearing a continuous glucose monitor leads to personalized dietary improvements that hold up beyond 12 weeks.
Continuous glucose monitors meaningfully change behavior in non-diabetic adults beyond the first month.
CGM use in metabolically healthy adults induces orthorexic-style dietary anxiety without health benefit.