Hengist Aaron, Ong Jude Anthony, McNeel Katherine, Guo Juen, Hall Kevin D
Laboratory of Biological Modeling, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD, United States.
Laboratory of Biological Modeling, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD, United States.
Am J Clin Nutr. 2025 Jan;121(1):74-82. doi: 10.1016/j.ajcnut.2024.10.007. Epub 2024 Dec 2.
Continuous glucose monitors (CGMs) are used to characterize postprandial glucose responses and provide personalized dietary advice to minimize glucose excursions. The efficacy of such advice depends on reliable glucose responses.
To explore within-subject variability of CGM responses to duplicate presented meals in an inpatient setting.
CGM data were collected from two inpatient feeding studies in 30 participants without diabetes, capturing 1189 responses to duplicate meals presented ∼1 wk apart from four 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 glucose for each 2-h postmeal period and compared within-subject, within-CGM responses to duplicate presented meals using linear correlations, intra-class correlation coefficients (ICC), and Bland-Altman analyses. Individual variability of interstitial glucose responses to duplicate meals were also compared with different meals using standard deviations (SDs).
There were weak-to-moderate positive linear correlations between within-subject iAUCs for duplicate meals [Abbott r = 0.46, 95% confidence interval (CI): 0.38, 0.54, P < 0.0001 and Dexcom r = 0.45, 95% CI: 0.39, 0.50, P < 0.0001], with low within-participant reliability indicated by ICC (Abbott 0.28, Dexcom 0.17). Bland-Altman analyses indicated wide limits of agreement (LoA) (Abbott -29.8 to 28.4 mg/dL and Dexcom -29.4 to 32.1 mg/dL) but small bias of mean iAUCs for duplicate meals (Abbott -0.7 mg/dL and Dexcom 1.3 mg/dL). The individual variability of interstitial glucose responses to duplicate meals was similar to that of different meals evaluated each diet week for both Abbott [SD 11.7 mg/dL (compared with duplicate P = 0.01), SD 10.6 mg/dL (P = 0.43), and SD 10.1 mg/dL] and Dexcom [SD 10.9 mg/dL (P = 0.62), SD 11.0 mg/dL (P = 0.73), and SD 11.2 mg/dL].
Individual postprandial CGM responses to duplicate meals were highly variable in adults without diabetes. Personalized diet advice on the basis of CGM measurements requires more reliable methods involving aggregated repeated measurements. This trial was registered at clinicaltrials.gov as NCT03407053 and NCT03878108.
连续血糖监测仪（CGM）用于描述餐后血糖反应，并提供个性化饮食建议以尽量减少血糖波动。此类建议的有效性取决于可靠的血糖反应。
探讨住院患者中CGM对重复提供的餐食反应的个体内变异性。
从两项针对30名无糖尿病参与者的住院喂养研究中收集CGM数据，获取了1189次对重复餐食的反应，这些餐食来自四种饮食模式，间隔约1周提供。一项研究使用了两种不同的CGM（雅培自由风格专业版和德康G4铂金版），而另一项研究仅使用了德康。我们计算了餐后每2小时血糖的增量曲线下面积（iAUC），并使用线性相关性、组内相关系数（ICC）和布兰德-奥特曼分析比较了个体内、同一CGM对重复提供餐食的反应。还使用标准差（SD）比较了重复餐食间组织间液葡萄糖反应的个体变异性与不同餐食间的变异性。
重复餐食的个体内iAUC之间存在弱至中度正线性相关性[雅培r = 0.46，95%置信区间（CI）：0.38，0.54，P < 0.0001；德康r = 0.45，95% CI：0.39，0.50，P < 0.0001]，ICC表明参与者内可靠性较低（雅培0.28，德康0.17）。布兰德-奥特曼分析表明一致性界限（LoA）较宽（雅培为-29.8至28.4 mg/dL，德康为-29.4至32.1 mg/dL），但重复餐食的平均iAUC偏差较小（雅培为-0.7 mg/dL，德康为1,3 mg/dL）。对于雅培[标准差11.7 mg/dL（与重复餐食相比P = 0.01），标准差10.6 mg/dL（P = 0.43），标准差10.1 mg/dL]和德康[标准差10.9 mg/dL（P = 0.62），标准差11.0 mg/dL（P = 0.73），标准差11.2 mg/dL]，重复餐食间组织间液葡萄糖反应的个体变异性与每周评估的不同餐食间的变异性相似。
在无糖尿病的成年人中，个体餐后CGM对重复餐食的反应高度可变。基于CGM测量的个性化饮食建议需要更可靠的方法，包括汇总重复测量数据。该试验在clinicaltrials.gov上注册，注册号为NCT03407053和NCT03878108。
