Zoe recommending libre for non diabetics

[Amity Island]

Blood sugar monitors are unnecessary for people without diabetes and could, in extreme cases, fuel eating disorders, leading doctors have warned.

They are part of a personalised diet trend, promoted on social media and spearheaded by companies including ZOE.

But NHS national diabetes advisor Prof Partha Kar said there is no strong evidence the gadgets help people without the condition.

ZOE said research is at an early stage but is "cutting edge".

Doctors question science behind blood sugar diet trend

Experts say there is "no strong evidence" the monitors, proven to be effective in managing diabetes, can also help people without the condition.

www.bbc.com

 

[Eddy Edson]

ZOE is such a scam.

Even if it were usfeul for non-diabetics to know how their BG reacts to different meals (which it generally isn't), CGM's are just not fit for this purpose.

Imprecision nutrition? Duplicate meals result in unreliable individual glycemic responses measured by continuous glucose monitors across three dietary patterns in adults without diabetes

Background Continuous glucose monitors (CGMs) are being used to characterize postprandial glycemic responses and thereby provide personalized dietary advice to minimize glycemic excursions. However, the efficacy of such advice depends on reliable CGM responses. Objective To explore...

www.medrxiv.org

Background Continuous glucose monitors (CGMs) are being used to characterize postprandial glycemic responses and thereby provide personalized dietary advice to minimize glycemic excursions. However, the efficacy of such advice depends on reliable CGM responses.
Objective To explore within-subject variability of CGM responses to duplicate meals in an inpatient setting.
Methods CGM data were collected in two controlled feeding studies (NCT03407053 and NCT03878108) in 30 participants without diabetes capturing 948 meal responses in duplicate ∼1 week apart from three dietary patterns. One study used two different CGMs (Abbott Freestyle Libre Pro and Dexcom G4 Platinum) whereas the other study used only Dexcom. We calculated the incremental area under the curve (iAUC) for each 2-h post-meal period and compared within-subject iAUCs using the same CGM for the duplicate meals using linear correlations, intra-class correlation coefficients (ICC), Bland-Altman analyses, and compared individual variability of glycemic responses to duplicate meals versus different meals using standard deviations (SDs).
Results There were weak to moderate positive linear correlations between within-subject iAUCs for duplicate meals (Abbott r=0.47, p<0.0001, Dexcom r=0.40, p<0.0001), with low within-participant reliability indicated by ICC (Abbott 0.31, Dexcom 0.16). Bland-Altman analyses indicated wide limits of agreement (Abbott -31.4 to 31.5 mg/dL, Dexcom -32.3 to 31.6 mg/dL) but no significant bias of mean iAUCs for duplicate meals (Abbott 0.1 mg/dL, Dexcom -0.3 mg/dL). Individual variability of glycemic responses to duplicate meals was similar to that of different meals evaluated each diet week for both Abbott (SDduplicate = 10.7 mg/dL, SDweek 1 =12.4 mg/dL, SDweek 2 =11.6 mg/dL, p=0.38) and Dexcom (SDduplicate = 11.8 mg/dL, SDweek 1 =12.2 mg/dL, SDweek 2 =12.4 mg/dL, p=0.80).
Conclusions Individual postprandial CGM responses to duplicate meals were unreliable in adults without diabetes. Personalized diet advice based on CGM measurements in adults without diabetes requires more reliable methods involving aggregated repeated measurements.

Translation: The variability of BG responses on different days to the same meal was similar to the variability for different meals.

You could argue that this experiment used older CGM versions. I bet 20c that using the latest versions wouldn't make much difference.

 

[AndBreathe]

ZOE is such a scam.

Even if it were usfeul for non-diabetics to know how their BG reacts to different meals (which it generally isn't), CGM's are just not fit for this purpose.

Imprecision nutrition? Duplicate meals result in unreliable individual glycemic responses measured by continuous glucose monitors across three dietary patterns in adults without diabetes

Background Continuous glucose monitors (CGMs) are being used to characterize postprandial glycemic responses and thereby provide personalized dietary advice to minimize glycemic excursions. However, the efficacy of such advice depends on reliable CGM responses. Objective To explore...

www.medrxiv.org

Background Continuous glucose monitors (CGMs) are being used to characterize postprandial glycemic responses and thereby provide personalized dietary advice to minimize glycemic excursions. However, the efficacy of such advice depends on reliable CGM responses.
Objective To explore within-subject variability of CGM responses to duplicate meals in an inpatient setting.
Methods CGM data were collected in two controlled feeding studies (NCT03407053 and NCT03878108) in 30 participants without diabetes capturing 948 meal responses in duplicate ∼1 week apart from three dietary patterns. One study used two different CGMs (Abbott Freestyle Libre Pro and Dexcom G4 Platinum) whereas the other study used only Dexcom. We calculated the incremental area under the curve (iAUC) for each 2-h post-meal period and compared within-subject iAUCs using the same CGM for the duplicate meals using linear correlations, intra-class correlation coefficients (ICC), Bland-Altman analyses, and compared individual variability of glycemic responses to duplicate meals versus different meals using standard deviations (SDs).
Results There were weak to moderate positive linear correlations between within-subject iAUCs for duplicate meals (Abbott r=0.47, p<0.0001, Dexcom r=0.40, p<0.0001), with low within-participant reliability indicated by ICC (Abbott 0.31, Dexcom 0.16). Bland-Altman analyses indicated wide limits of agreement (Abbott -31.4 to 31.5 mg/dL, Dexcom -32.3 to 31.6 mg/dL) but no significant bias of mean iAUCs for duplicate meals (Abbott 0.1 mg/dL, Dexcom -0.3 mg/dL). Individual variability of glycemic responses to duplicate meals was similar to that of different meals evaluated each diet week for both Abbott (SDduplicate = 10.7 mg/dL, SDweek 1 =12.4 mg/dL, SDweek 2 =11.6 mg/dL, p=0.38) and Dexcom (SDduplicate = 11.8 mg/dL, SDweek 1 =12.2 mg/dL, SDweek 2 =12.4 mg/dL, p=0.80).
Conclusions Individual postprandial CGM responses to duplicate meals were unreliable in adults without diabetes. Personalized diet advice based on CGM measurements in adults without diabetes requires more reliable methods involving aggregated repeated measurements.

Translation: The variability of BG responses on different days to the same meal was similar to the variability for different meals.

You could argue that this experiment used older CGM versions. I bet 20c that using the latest versions wouldn't make much difference.

Did you read the term of either of those studies? I’m not sure I’d wager the farm on any study with an active time frame of 14 days.

I realise the Libre lifespan is 14 days also, but I also believe people should have the right and ability to decide for themselves is something is helpful to them.

Libre does not appear to be in short supply any more, so it concerns me not if those not requiring it, medically, are using it.

 

[Inka]

It concerns me because not only is there a risk of eating disorders, it can cause completely unnecessary stress. I’m on another forum (not diabetes) and people there keep obsessing about ‘spiking’ up to 7. It also trivialises the experiences of people with diabetes who actually need them. They’re not a toy to wear on your arm and obsess over or parade as a ‘do ask me how interesting I am’ badge. I’d like to give some of those people Type 1 for a week so that could see exactly why CGMs are crucial and not a fun toy you can toss away when you choose.

 

[Amity Island]

It concerns me because not only is there a risk of eating disorders, it can cause completely unnecessary stress. I’m on another forum (not diabetes) and people there keep obsessing about ‘spiking’ up to 7. It also trivialises the experiences of people with diabetes who actually need them. They’re not a toy to wear on your arm and obsess over or parade as a ‘do ask me how interesting I am’ badge. I’d like to give some of those people Type 1 for a week so that could see exactly why CGMs are crucial and not a fun toy you can toss away when you choose.

I am quite concerned about availability for those that actually need them (us). Seems something off with this, doesn't seem like a legitimate problem to resolve.

 

[Eddy Edson]

Did you read the term of either of those studies? I’m not sure I’d wager the farm on any study with an active time frame of 14 days.

I realise the Libre lifespan is 14 days also, but I also believe people should have the right and ability to decide for themselves is something is helpful to them.

Libre does not appear to be in short supply any more, so it concerns me not if those not requiring it, medically, are using it.

If you read the paper you see that Hall et al say that maybe with repeated testing it might be possible to predict glycemic response to a meal based on the past outcomes.

So, yes, you can imagine a theoretically use case where people record CGM readings from the exact same meals eaten on multiple days and get comfortable that a bowl of soup plus a serve of the salmon mousse with a green salad will give a postprandial peak of 6.4 on average versus a regular chicken pho with a side of edamame and a piece of watermelon at 6.7. But I don't think you can imagine anybody actually doing that, or being interested in it.

What you can imagine is somebody noticing that an apple sometime "spikes" them to 7.0 where bacon never does, and deciding that fruit is toxic - because that kind of scenario happens a lot IRL, and because ZOE's marketing tells them they should worry about it. The problem is that eating bacon instead of apples is an exceptionally bad move, for health.

Of course if you're a caveat emptor-maximalist then it's that person's own damn fault and we don't need regulations & enforcement & attention attempting to protect people from potenitally harmful scams.

 

[Bloden]

Just ripping off the worried well and, as you say @Inka, tipping people over into eating disorders. It’s disgraceful money-grubbing by a “respected” professor, Tim Spector. If I still had binge-eating disorder, I’d be throwing my money at Zoe too, and crawling deeper into the miserable obsession/isolation that I went through back then...😡

 

[AndBreathe]

Just ripping off the worried well and, as you say @Inka, tipping people over into eating disorders. It’s disgraceful money-grubbing by a “respected” professor, Tim Spector. If I still had binge-eating disorder, I’d be throwing my money at Zoe too, and crawling deeper into the miserable obsession/isolation that I went through back then...😡

But surely, the issue there would be the binge eating dosirder, not someone else?

(I am post-ED. I own it. I did it. I just didn't understand what at the time. A ZOE style outfit would not have influenced me, personally.)

 

[Kol]

Libre does not appear to be in short supply any more, so it concerns me not if those not requiring it, medically, are using it.

It is concerning, after all isn't that how the Ozempic shortage started?

It is concerning if any medication or equipment at all is used by people unnecessarily.

 

[AndBreathe]

It is concerning, after all isn't that how the Ozempic shortage started?

It is concerning if any medication or equipment at all is used by people unnecessarily.

Libre was in short supply for some time, after launch, but Abbott’s supply chains seem more robust these days. People, like body builders have been utilising tools, like Libre and other “helpers” for a long time.

On your second point, I agree with you, but the necessary/unnecessary debate is much bigger than Libre.

 

[Bruce Stephens]

It is concerning, after all isn't that how the Ozempic shortage started?

Even for things like Ozempic, I presume the demand will cause production to rise (especially if it can be licensed for wider sale).

In any case, I think pills that promise to make people slimmer without much effort are always likely to be vastly more popular than a device like Libre which might (possibly) tell you something which might (conceivably) be meaningful in some vague sense about your responses to food and exercise if you look at the graphs carefully.

 

[Inka]

Body builders have been (mis)using insulin for ages too. That doesn’t make it a good thing.

 

[Maz2]

I was reading this the other day. I took part in the ZOE study Covid research and was asked if I would like to take part in the blood sugar study. I was pre-diabetic in 2017 and 2018, normal 2019, 2020 and 2023 and awaiting results from the latest check. I accepted as I thought it would help medical research but was then informed I had to pay to take part in it so I declined. I have taken part in a blood donor study previously, a cardiovascular study who found the pre-diabetes and also with Biomed, none of whom expected me to pay for the privilege.

I once said that if they brought in payment for blood donors I wouldn't go as I think it is a poor society if people cannot give some of their blood to help save lives free of charge!!

I agree about non diabetics. I check mine as I feel I need to know which foods are going to spike me but even I sometimes start panicking if something goes up to 7 so I can see the point you are making and that the researchers into diabetes are making.

 

[Bloden]

But surely, the issue there would be the binge eating dosirder, not someone else?

(I am post-ED. I own it. I did it. I just didn't understand what at the time. A ZOE style outfit would not have influenced me, personally.)

Hmmm, I didn’t develop an eating disorder in a vacuum - there were external pressures.

 

[AndBreathe]

Hmmm, I didn’t develop an eating disorder in a vacuum - there were external pressures.

Similarly to the external pressured impacting some of those who become alcohol dependent, but thus far, we haven't banned that. Indeed we advertise it.

 

[Inka]

Similarly to the external pressured impacting some of those who become alcohol dependent, but thus far, we haven't banned that. Indeed we advertise it.

The use of CGM is crucial for people on insulin. It’s hardly comparable to alcohol. A better comparison would be people using anti-alcohol drugs when they don’t need them.

 

[AndBreathe]

The use of CGM is crucial for people on insulin. It’s hardly comparable to alcohol. A better comparison would be people using anti-alcohol drugs when they don’t need them.

My reply was to Bloden, who stated her ED was not isolated, but had external pressures. I was merely pointing out that, in my view, it is not credible to remove all potential external pressures from all folks.

On the topic of cricial for insulin dependent diabetics, I would agree testing is crucial. CGMs are undoubtedly a very good and convenient way of testing, but I would argue crucial.

For the avoidance of doubt, I do not grudge people living with insulin dependent diabetes CGMs.

 

[Inka]

You forget the CGM alarms @AndBreathe As you don’t take insulin, you have no idea of how much difference they make.

While all external contributors to eating disorders can’t be removed, the unnecessary use of CGMs by the worried well can be. It’s adding to the number of people with disordered eating not just potentially affecting people who already have an eating disorder. To use your alcohol example, we have rules around alcohol. We haven’t banned it but we try to control who drinks it and who’s exposed to advertising for it.

 

[AndBreathe]

You forget the CGM alarms @AndBreathe As you don’t take insulin, you have no idea of how much difference they make.

While all external contributors to eating disorders can’t be removed, the unnecessary use of CGMs by the worried well can be. It’s adding to the number of people with disordered eating not just potentially affecting people who already have an eating disorder. To use your alcohol example, we have rules around alcohol. We haven’t banned it but we try to control who drinks it and who’s exposed to advertising for it.

Sorry, but I still don't think a CGM is crucial. As I understand it, the vast majority of those using insulin are hypo aware, so do have clues. If, say, you have a sensor failure, you will be very unlikely to be in immediate danger.

On that basis, I reiterate, a CGM is highly desirable, not crucial.

Maybe I'm a horrid, heartless person. Rhetorical.

 

[Amity Island]

Sorry, but I still don't think a CGM is crucial. As I understand it, the vast majority of those using insulin are hypo aware, so do have clues. If, say, you have a sensor failure, you will be very unlikely to be in immediate danger.

On that basis, I reiterate, a CGM is highly desirable, not crucial.

Maybe I'm a horrid, heartless person. Rhetorical.

I'd never want to go back to finger pricking. The libre is the best thing invented since insulin. Its transformed my life. I'm concerned about supply issues if non-diabetics start using them.