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

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Merino, Jordi, Linenberg, Inbar, Bermingham, Kate M, Ganesh, Sajaysurya, Bakker, Elco, Delahanty, Linda M, Chan, Andrew T, Capdevila Pujol, Joan +7 more·2022·The American Journal of Clinical Nutrition
DOI 10.1093/ajcn/nqac026PMC PMC9170468
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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 τ 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 τ 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.This trial was registered at clinicaltrials.gov as NCT03479866.

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  • Baseline glucose CV in ITT data was higher than previous reports demonstrating strong reproducibility and concordance between devices within participants of 3.7% median CV (IQR 1.7%-7.1%).

    “Review of the intent-to-treat (ITT) baseline glucose CGM data exhibited higher coefficient of variation (CV) than previous reports demonstrating a strong reproducibility and concordance between devices within participants of 3.7% median CV (IQR 1.7%-7.1%)(20).”

    From Prebiotic soda lowers postprandial glucose compared to traditional soda pop: a randomized controlled trial (2025) · cites this paper as [20]

    The Results (Concordance in glycemic responses) report a median 3.7% CV (IQR 1.7%–7.1%) for agreement between same-brand devices measuring glucose response after standardized meals. That figure is not a baseline glucose CV, and the reported within-person variability for the same meal on different days is substantially higher. The citing paper's ITT baseline comparison is its own finding, not one established by this source. (LLM, conf=0.88)

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Research works printed but not linked: 23

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Authors
Merino, J., Linenberg, I., Bermingham, K. M., Ganesh, S., Bakker, E., Delahanty, L. M., Chan, A. T., Capdevila Pujol, J., Wolf, J., Al Khatib, H., Franks, P. W., Spector, T. D., Ordovas, J. M., Berry, S. E., & Valdes, A. M.
Affiliations
  • Broad Institute (US)
  • ZOE (United Kingdom) (GB)
  • King's College London (GB)
  • Harvard University (US)
  • University of Nottingham (GB)
Corresponding author
Berry, Sarah E
ORCID
Venue
The American Journal of Clinical Nutrition
Publisher
Elsevier BV
Published
2022-06
Volume
115
Issue
6
Pages
1569-1576
ISSN
0002-9165 (ISSN-L)
DOI
10.1093/ajcn/nqac026
PMC
PMC9170468
OpenAlex
W4212862774
Cited by
46
References
7
Citations by year
2026: 15 · 2025: 9 · 2024: 11 · 2023: 8 · 2022: 3
FWCI
5.50
Type
journal article
Language
en
Open access
Licence
Locations
  • American Journal of Clinical Nutrition (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Research Portal (King's College London) (publishedVersion, other-oa)
  • DIGITAL.CSIC (Spanish National Research Council (CSIC)) (submittedVersion, cc-by)
  • Lund University Publications (Lund University) (submittedVersion)
Funders
  • Wellcome Trust
  • Medical Research Council
  • Versus Arthritis
  • Chronic Disease Research Foundation
  • NIHR
  • CRN
  • Biotechnology and Biological Sciences Research Council (BB/NO12739/1)
  • MGH (R35 CA253185)
  • PWF
  • European Research Council (CoG-2015_681742_NASCENT)
  • Swedish Research Council
  • Novo Nordisk Foundation
  • Swedish Foundation for Strategic Research
  • National Institute for Health Research
  • European Union
  • Biomedical Research Centre
  • American Diabetes Association (#7-21-JDFM-005)
  • NIH (P30 DK40561)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Nutrition, Genetics, and Disease
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
continuous glucose monitoring, postprandial glycemic response, personalized nutrition, glycemic variability, time in range, Dexcom G6, ad libitum meal, device reliability, personalized dietary recommendations
MeSH terms
Blood Glucose, Diet, Glucose, Humans, Blood Glucose Self-Monitoring, Reproducibility of Results, Meals

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