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

Authors: MERINO, JORDI - Massachusetts General Hospital; LINENBERG, INBAR - Zoe Global Limited; BERMINGHAM, KATE - King'S College; GANESH, SAJAYSURYA - Zoe Global Limited; BAKKER, ELCO - Zoe Global Limited; DELAHANTY, LINDA - Harvard Medical School; CHAN, ANDREW - Harvard Medical School; PUJOL, JOAN - Zoe Global Limited; WOLF, JONATHAN - Zoe Global Limited; AL KHATIB, HAYA - Zoe Global Limited; FRANKS, PAUL - Lund University; SPECTOR, TIM - King'S College; ORDOVAS, JOSE - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; BERRY, SARAH - King'S College; VALDES, ANA - University Of Nottingham

Submitted to: The American Journal of Clinical Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 1/24/2022
Publication Date: 2/4/2022
Citation: Merino, J., Linenberg, I., Bermingham, K.M., Ganesh, S., Bakker, E., Delahanty, L.M., Chan, A.T., Pujol, J.C., Wolf, J., Al Khatib, H., Franks, P.W., Spector, T.D., Ordovas, J.M., Berry, S.E., Valdes, A.M. 2022. Validity of continuous glucose monitoring for categorizing glycemic responses to diet: implications for use in personalized nutrition. American Journal of Clinical Nutrition. https://doi.org/10.1093/ajcn/nqac026.
DOI: https://doi.org/10.1093/ajcn/nqac026

Interpretive Summary: Continuous glucose monitor (CGM) devices enable the individual's continuous measurement of circulating glucose levels. However, there are concerns about their reliability for categorizing the glucose responses to foods that would limit their potential application in personalized nutrition recommendations. Therefore, scientists at the HNRCA in Boston, in collaboration with researchers in the USA and Europe, evaluated the concordance of two simultaneously worn CGM devices in measuring glucose response after a meal. This was carried out in 394 participants of the PREDICT 1 trial who wore the two devices simultaneously for up to 14 days and consumed a total of 10,195 meals. Our data demonstrated strong concordance of CGM devices in monitoring glucose responses and support their potential use in personalized nutrition.

Technical Abstract: 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 tau 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 tau 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.