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What do continuous glucose monitors have to do with mental health?


Continuous glucose monitors for mental health

Medicine and health are moving in the direction of providing more individualized care through precision medicine. Precision medicine, in a nutshell, is a way to provide more effective, more individualized treatment based on an individual's unique genetic and non-genetic makeup.


Biomarkers are used to help determine the best treatment and can be collected from genetic testing, wearable technology (Whoop, Oura Ring, continuous glucose monitors), and body specimens such as urine, blood, and saliva. Using this data can help guide treatment decisions and decrease the guesswork of the best treatment for an individual.


Rapid Growth of CGMs in the metabolic health/biohacking field


Continuous glucose monitors (CGM) fall under the umbrella of wearable technology and can help patients (and their providers) make changes to their diet and exercise habits based on their glucose levels. They are best known as a helpful tool for individuals with diabetes manage blood glucose in real-time.


More recently, CGMs have been picking up interest amongst the biohacking crowd - individuals interested in extending longevity and improving human performance through metabolic health. The rapid growth of CGMs for metabolic health has resulted in the actual CGM devices becoming more discrete with a more intuitive interface for users.


It was only ten years ago that it seemed unfathomable that people would be utilizing wearable technology that tracked sleep and other measures of health. Now, there is exponential annual growth at a rate of 20% (Ometov, 2021) . Wearable technology is becoming a part of our culture with more than 30% of individuals in the United States utilizing some form of wearable technology (Chandrasekaran, 2020). Every year, there are new devices, sensors, and apps coming out in the wearable technology field.



Continuous Glucose Monitoring and Mental Health


From a Public Health Lens

Like much of precision medicine, there is huge potential for CGMs to be helpful from a public health perspective by preventing metabolic syndrome in individuals who are either healthy or have pre-diabetes. Metabolic syndrome is associated with increased risk of mood symptoms and decreased quality of life (Ho, 2014).


Anxiety and Continuous Glucose Monitors

Utilizing a CGM can reduce anxiety since people would be able to monitor and better stabilize their blood glucose throughout the day by eating foods that don't cause glucose spikes and dips for that individual. Blood glucose spikes and dips can increase anxiety symptoms (Aucoin, 2016).


However, just like any wearable technology, continuous blood glucose monitoring may also lead to more health anxiety, obsessional thinking, and compulsive monitoring for some individuals.


Impact on sex

Individuals wear CGMs either on the back of their arm or on their abdomen, which can be very unsexy and can actually interfere with sex. One study done through an online survey found that among adults with Type 1 DM, CGMs interfered with sexual activity in 20% of users (Robertson, 2020). The location of the CGM on the participant was not specified in the study, however. Perhaps CGM placement on the arm would interfere less with sex than abdominal placement.



Overall conclusions of CGMs for mental health

The impact of CGMs on mental health for non-diabetic individuals is still being investigated. Based on what we know about the overall benefits of blood glucose stabilization for anxiety, focus, and mood, CGMS are likely a helpful tool for indirectly improving mental health symptoms.



Looking to get started with a Continuous Glucose Monitor?


Getting a Prescription

You'll need a prescription from a physician, PA, or nurse practitioner for a continuous glucose monitor. At this point, if you ask a provider for a CGM prescription, they likely won't be aware of their use for metabolic health and may not be interested in ordering one for you. However, some functional medicine and integrative physicians are following CGM developments (or even use them too) and can order one for you. It's a good idea to ask.


Another option is to go through a company such as Levels, Supersapiens, Nutrisense - or if you're looking to really dive in, you can check out the company, Zoe, which also utilizes gut microbiome testing (my two cents is that the science isn't quite ready for a commercial gut microbiome testing product). If you go this route, you'll fill out a health questionnaire and be prescribed a CGM from their clinical staff. Many of these companies have their own apps which make the glucose data easy to read and review. The actual CGMs have apps too but they are not nearly as user-friendly.


Cost

Health insurance companies will not cover the cost of CGMs unless someone has a diagnosis of diabetes and there is a pretty steep monthly cost. If you utilize a company such as Levels, Supersapiens, or Nutrisense, there will likely be a recurring fee as high as $199/month that includes the sensors, as well as an annual fee. Make sure to read the fine print about the costs of these products. Keep in mind that you don't have to wear a CGM longterm - you can also just try it for a month or two in order to better understand how your body responds to different food.


Types of CGMs

The two most commonly used CGMs for metabolic health are Abbott's Libre Sense and Dexcom G6. They can be inserted into the abdomen or the back of the arm and need to be replaced every two weeks. The Dexcom G6 provides continuous data - and while the Libre Sense does too, users need to scan the CGM sensor with their phones in order to obtain the data.


Dr. Burger's take on what it is like to wear a CGM

Full disclosure - I tried wearing a CGM to see what it was actually like and to get a better understanding of how my blood glucose is affected by different food. I only tried it for a week because the sensor was uncomfortable on my abdomen - there was mild pain with it so I was always aware of it.


I received the Dexcom G6 from Levels and the instructions were to insert it on my abdomen (no mention of upper arm though upon further research for this article, I now know I could have inserted it on my upper arm instead).


I found the actual data really informative and it definitely positively impacted what I ate - I was more aware of the effects of sweets and was more likely to not eat high sugar foods.


I didn't wear it long enough to notice any impact on my own mental health - and the discomfort of it probably had at least a mild negative impact on my mood/anxiety.






References

Aucoin M, Bhardwaj S. (2016). Generalized Anxiety Disorder and Hypoglycemia Symptoms Improved with Diet Modification. Case Rep Psychiatry. doi: 10.1155/2016/7165425.


Chandrasekaran R, Katthula V, Moustakas E (2020). Patterns of Use and Key Predictors for the Use of Wearable Health Care Devices by US Adults: Insights from a National Survey. J Med Internet Res., 22(10):e22443. doi: 10.2196/22443.


Ho, C., Zhang, M., Mak, A., & Ho, R. (2014). Metabolic syndrome in psychiatry: Advances in understanding and management. Advances in Psychiatric Treatment,20(2), 101-112. doi:10.1192/apt.bp.113.011619


Ometov A, Shubina V, Klus L. et al. (2021). A Survey on Wearable Technology: History, State-of-the-Art and Current Challenges,Computer Networks, 193. doi:

https://doi.org/10.1016/j.comnet.2021.108074.


Robertson C, Lin A, Smith G, et al. (2020). The Impact of Externally Worn Diabetes Technology on Sexual Behavior and Activity, Body Image, and Anxiety in Type 1 Diabetes. Journal of Diabetes Science and Technology,14(2):303-308. doi:10.1177/1932296819870541