Integrative GP and Vively Medical Director
January 30, 2023
We’re in the midst of a metabolic health crisis in Australia, and there is plenty of evidence to suggest that CGMs may be a powerful tool in the prevention and reversal of this crisis.
We are in the midst of a metabolic health crisis.
The latest stats from the Australian bureau of statistics, revealed that 67% of Australian adults are either overweight or obese. A number that has been steadily rising over the past four decades.
There are now an estimated 422 million people world-wide who live with type 2 diabetes, and a further 7.5% of the world’s population with pre-diabetes. Add to this the burden of metabolic syndrome, which is estimated to be affecting at least 25% of Australians (a likely underestimate of the true numbers) and we have ourselves a major health crisis — one that is becoming somewhat normalised.
Normalisation is a widespread social phenomenon where previously uncommon ideas, beliefs, and conditions gradually become accepted as the norm. This process is increasingly evident in issues such as stress, burnout, obesity, frailty, cognitive impairment, and metabolic syndrome.
The danger of normalisation lies in the perception that diseases and health issues are an inevitable part of ageing, when in fact, there is no concrete evidence to support this notion. Over the past 60 years, we have witnessed an increase in unhealthy habits driven by factors such as consumerism, food processing, market economics, longer working hours, and escalating stress levels. These factors contribute to the rise in metabolic health problems that are now becoming more prevalent and normalised in our society.
By recognising and addressing the normalisation of these health issues, we can raise awareness and promote healthier lifestyle choices. Encouraging people to adopt preventive measures and make informed decisions about their health can help reverse the trend of these growing problems, ultimately leading to a healthier and more resilient society.
Metabolic health refers to the proper functioning of the body's metabolic processes. This involves the conversion of food into energy, growth and repair of cells, and maintenance of vital functions. Good metabolic health is characterised by a balanced interplay of various factors, such as:
Your metabolism is the body's way of responding to the energetic needs for optimal functioning. It adapts based on the internal and external environment. The body is constantly analysing what it needs to do to survive. It tunes into how much glucose, fat and protein there is to utilise in order to service those needs.
At Vively, instead of aiming for a high/fast metabolism, we strive for a highly adaptive metabolism — one that can respond to one’s needs.
These tests are limited though, as they don't measure insulin resistance or glucose variability. This is important because these two variables are significantly under diagnosed and associated with poor outcomes overall and chronic cardiovascular diseases.
A continuous glucose monitor (CGM) is a device that allows for real-time tracking of blood glucose levels. It functions by employing a small sensor, typically inserted just below the skin, to measure glucose levels in the interstitial fluid. These measurements are then transmitted to a mobile device, providing users with continuous updates and trends of their glucose levels.
While CGMs have been used in people with diabetes for decades, they do have important uses for people without diabetes too. They have the ability to provide valuable insights into how an individual's body responds to different foods, exercise, sleep and stress. By monitoring their glucose levels, CGMs for non-diabetics can help them make more informed decisions about their ifestyle to optimise their overall health. This can potentially avoid the development of pre-diabetes or diabetes.
CGM devices can help athletes or fitness enthusiasts fine-tune their performance by understanding how their glucose levels fluctuate during their training and competitions. This information may lead to better fuelling strategies and improved recovery, ultimately enhancing athletic performance.
CGM technology has also made the ability to check for glucose variability much easier. Glucose variability reveals how many glucose highs and lows the person may be experiencing. Higher variability is associated with increased risk of all-cause mortality and cardiovascular events. Although we aim to avoid high blood glucose levels in those with type 2 diabetes, it is also known that high levels of glucose variability is problematic for non-diabetics as well.
This means CGMs have the potential to help with disease prevention. CGMs can give people early access to how their metabolism works. They show you the effects of your lifestyle choices on your metabolic responses in real-time. They can offer you the motivation, resolve and knowledge that is unique to you, to help you change your behaviours.
A 2020 article published in the Journal Clinical Diabetes surveyed a group of diabetics to ascertain the impact of CGMs on lifestyle choices. It found:
Another study in non-diabetic individuals found that a significant number of participants did have abnormal glucose regulation. The CGM was a critical factor in revealing this underlying abnormality. This would not have been uncovered using the standard single point in time blood tests.
This means our current ways of measuring glucose intolerance and type 2 diabetes is sub-standard and that we are at risk of missing the diagnosis in non-symptomatic people.
Vively is the first company in Australia to bring blood glucose monitoring to those without diabetes to improve their metabolic health.
Between August 2022 and December 2022, Vively collected over 500,000 glucose readings. This data showed a higher-than-expected rate of potential metabolic dysfunction.
More than 66% of users have an estimated HbA1c of 5.7% or greater — which by our current standards would put them in the pre-diabetes category. These figures are being found in users who have not reported any known metabolic dysfunction.
More research is needed and it is not standard to diagnose a metabolic issue from CGM data alone, but the trend is definitely something worth looking more closely at.
Modern medicine has shifted from primarily treating infectious diseases and traumas to addressing lifestyle-related diseases and mental health.
As a result, doctors now need to educate patients about the factors contributing to their lifestyle diseases, taking on roles such as nutritionist, counsellor, psychologist, and coach. Early identification of glucose dys-regulation and insulin resistance, which can be present up to 15 years before a full-blown type 2 diabetes diagnosis, is essential for promoting interventions that can reverse metabolic dysfunction and prevent chronic disease progression.
Health literacy, particularly about nutrition, is critical for individuals to understand their role in managing their health. However, conflicting and confusing messaging has led to poor health literacy for many people.
CGMs have the potential to be a game-changer for individuals struggling to understand the impact of different foods on their health. Studies have shown that people have different glucose responses to the same meal, highlighting the need for personalised nutrition. With growing research on the role of the gut biome in food choices, cravings, and satiation, CGMs may help revolutionise personalised healthcare and empower individuals to manage lifestyle-related diseases more effectively.
CGM technology is relatively new and research is still burgeoning. Therefore, we don’t yet have solid evidence to ascertain whether wearing a CGM has any negative impact or puts the users at risk of mis-diagnosis.
We don’t know if using CGM sensors in non-diabetics negatively affects a person’s relationship to food, whether disordered eating may increase or whether the impacts are short lived and therefore statistically not relevant long-term. We also lack international consensus for hypoglycaemic levels, which may have unknown implications, and the true impact on behaviour change is yet to be fully explored.
It's important to note that the research suggests support from a health professional for proper interpretation of the data may be a critical factor for successful long-term behaviour modification and treatment decision-making.
In conclusion, the number of people affected by metabolic syndrome, pre-diabetes, PCOS and type 2 diabetes continues to rise each year, placing a significant financial, practical, and societal burden on healthcare systems.
To truly focus on prevention, intermittent use of CGM systems could provide individuals with a personalised understanding of how their lifestyle choices impact their blood glucose levels. It is widely known that improving diet, exercise, sleep, and stress management are crucial for better health, and a technology that offers data on the interplay between these factors is invaluable.
By increasing the accessibility of CGMs to the general public, patients, healthcare providers, and governments will have a powerful tool to better comprehend and address this growing health crisis.