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Going down the ‘rabbit hole’ of wearable blood-sugar monitors

Blood-sugar monitoring devices could soon be on the arms of millions of Americans after regulators cleared two new devices for use without a prescription. Is it a way to improve our health? Or is the data just another distraction?

https://www.bbc.com/news/articles/c1ddk1ddme5o

Excerpt:

.....Continuous glucose monitors (CGMs), which monitor glucose levels in real time, have been used by millions of diabetics for years. As a dietitian in Ontario, Canada, Ms Bekkedam had hers installed to better understand the technology for her patients with diabetes.

But her two-week trial became somewhat of a cautionary tale.
“I was freaking out,” she said. “I actually questioned, oh my goodness, do I have diabetes?”

She didn’t. And, after some extra research, she found that her glucose levels were entirely normal. But constantly getting updates on her blood sugar highs and lows, without having a medical condition that required it, incited some unnecessary fear.

“That’s where I think people could go down a rabbit hole,” she said.

But these devices may be in the hands - or on the arms - of many more people very soon, thanks to two recent Food and Drug Administration (FDA) approvals for more widespread use. This week, Abbott Laboratories announced it had received federal clearance for two over-the-counter CGMs, including one for those without diabetes.

Use of CGMs is already rising, with the tell-tale arm patches easily spotted during morning commutes in major American cities. But experts say that even if there is no proven harm, there is little evidence to warrant spending the hefty fees - as much as $300 (£240) a month - if you’re not a diabetic.

Abbott’s Lingo, which is a CGM for people without diabetes, is marketed to consumers “who want to better understand and improve their health and wellness”. It was one of two devices cleared by the FDA for sale, and is already available in the UK. The FDA’s 510(k) regulatory process evaluates medical devices for safety and efficacy, but marketing claims are not part of the review.

.....Abbott said that flattening glucose curves could help improve energy, mood and sleep and pointed to studies showing the impact of glucose spikes on overall health, and the role of CGMs in monitoring them.

There is scepticism about such claims in the medical community, but one thing experts agree on is that CGMs have significantly improved the care of some people living with diabetes.

Type 1 diabetes is when an individual’s pancreas stops producing insulin, so regular injections are needed. Type 2 diabetes is more common and occurs when the cells in the body become resistant to insulin and so more is needed to keep blood glucose levels within a normal range. It can usually be controlled through medication, diet, exercise and close monitoring, although some take insulin. Traditionally, diabetics monitored their blood sugar with finger-prick tests, but CGMs can alert people with diabetes when their blood sugars are running dangerously high and low, and if insulin needs to be injected.

But many experts say that the evidence for CGMs improving the health of non-diabetics is effectively non-existent. They insist the devices are, at best, a distraction and at worse could lead to dangerous fixations.

A growing trend

CGMs are big business. Market leaders have estimated sales will reach $20bn globally over the next four years.

Earlier this year, the FDA cleared the sale of an over-the-counter CGM made by Dexcom, meant for Type 2 diabetics who don’t use insulin but want to avoid regular finger-prick tests. And some new CGM startups, like Signos, Nutrisense and Levels Health, now market prescription devices off-label as tools for energy, mood and metabolism.

The devices are becoming popular among some in health, wellness and sports industries.

Dutch marathoner Abdi Nageeye, who will compete in the Paris Olympics, told Reuters earlier this week he is wearing a CGM to try to better track his body’s available energy.

.....A solution in search of a problem

But while some researchers and businesses claim that CGMs can have great benefits for the average person, many in the scientific community are sceptical, pointing to a lack of evidence.

Spikes in glucose are a symptom - not a cause - of diabetes, said Oxford researcher and dietitian Dr Nicola Guess. She said there is “no benefit” to CGMs for those who are not diabetic.

“Normally you would identify a problem and invent a solution to fix it,” she told the BBC. “This is backwards. It’s like we’ve got this technology, now we just have to find groups of people who we can convince that they need this technology.”

One key issue experts point to is that it is surprisingly hard to find much data on what blood sugar patterns look like in people without diabetes. This makes it hard to interpret an individual’s results in a meaningful way.

And most people’s sugars will spike with fruit - a food group rich with vitamins and nutrients - but that’s not a reason to stop eating it.

Dr Ethan Weiss, a clinical cardiologist with the University of California, San Francisco, agreed there is scant evidence that tracking glucose levels in people without diabetes can measurably improve their health.

“I’m aware of studies that show you can change your diet and you can decrease glucose spikes. I’m not aware of any studies showing that [tracking glucose] is actually doing anything beneficial, in a meaningful way, like reducing your risk of disease,” he said. “I think mostly it’s the devotees who believe it.”

But, Dr Weiss added, he was not aware of any studies showing the CGMs caused damage, either.

Others, including Dr Guess, said that the potential for harm was very real. Instead of focusing on the foundational building blocks of health - things like regular exercise, and a nutrient-rich diet - trackers like CGMs encourage us to focus on the minutiae of imperfect metrics. And, in worst-case scenarios, they can foster new problems, like disordered eating.

“I worry that instead of doing simple things to improve our health we are turning mealtimes into scientific experiments,” she said.

“I just feel like in some ways people have forgotten the point of living.”
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Have a very good friend who is a Type 1 insulin dependent diabetic. Dexcom CGM, for him, is a life saver. Before he had it he was constantly experiencing extreme low blood sugar that required the ambulance to be called to revive him. He told me from 2010-2020 he had 30 ambulance 911 calls due to his extreme low blood sugar. He joking told me that due to this the ambulance crews knew him and would recognize him when in the store or out in town. It eventually resulted in him totaling his car when he had one while driving. He left the ER unharmed by the accident, but afterwards was able to show his insurance company that the Dexcom CGM was a medical necessity. Since he has had it he has had zero incidents of extreme low blood sugar and has had no contact with ambulances.

Having said that, allowing non-diabetics to get the CGM is nothing but a marketing tool to allow the manufacturers expansion of their potential CGM users. Hypochondriacs and anorexics will use CGMs to their detriment.

I agree with the article in that this is a solution looking for a problem to fix. Sounds like government doesn’t it.

Banana giant held liable for funding paramilitaries

https://www.bbc.com/news/articles/c6pprpd3x96o

Excerpt:

Chiquita said in a statement that it intended to appeal against the jury’s verdict, arguing that there was “no legal basis for the claims”.

The jury in the case, which was heard in a federal court in South Florida, found Chiquita responsible for the wrongful deaths of eight men killed by the AUC.

The AUC engaged in widespread human rights abuses in Colombia, including murdering people it suspected of links with left-wing rebels.

The victims ranged from trade unionists to banana workers.
The case was brought by the families after Chiquita pleaded guilty in 2007 to making payments to the AUC.

During the 2007 trial, it was revealed that Chiquita had made payments amounting to more than $1.7m to the AUC in the six years from 1997 to 2004.

The banana giant said that it began making the payments after the leader of the AUC at the time, Carlos Castaño, implied that staff and property belonging to Chiquita’s subsidiary in Colombia could be harmed if the money was not forthcoming.

Lawyers for Chiquita argued that the company had no choice but to pay the AUC to protect its Colombian employees from violence.

But the plaintiffs argued that the company formed “an unholy alliance with the AUC” at a time when Chiquita was expanding its presence in regions controlled by the AUC.

The regular payments continued even after the AUC was designated by the US as a foreign terrorist organisation in 2001.