Podcast Summary
Exploring CGM, Performance Physiology, and Sleep with Bob Kaplan: Understanding mean glucose, glucose variability, and glucose spikes is crucial for effective CGM interventions. CGM benefits extend beyond diabetes management, and the Aura sleep wearable is a notable innovation.
Host Peter Atia and guest Bob Kaplan answered several follow-up questions on these topics, revealing new insights and considerations. They also touched on performance physiology and cycling during the recording, which took place during the Tour de France. For those interested in CGM, Atia shared his framework for interventions, emphasizing the importance of understanding mean glucose, glucose variability, and glucose spikes. The conversation also addressed the use of CGM for non-diabetics, as discussed in a recent JAMA perspective. Additionally, they discussed the Aura sleep wearable and answered exercise-related questions. Whether you're a seasoned expert or just starting to explore these topics, this episode offers valuable information and insights that can help deepen your understanding. To access the full episode and additional membership benefits, visit PeterAtiaMD.com/subscribe.
8 questions for evaluating interventions: Consider the risks, benefits, and opportunity costs when assessing interventions to ensure a balanced evaluation
When evaluating any intervention, be it a medication or a practice like meditation, it's essential to consider three key questions: what is the risk of harm, what is the probability of benefit, and what is the opportunity cost? The first two questions are straightforward - what are the potential negative consequences and positive outcomes? However, the third question, the opportunity cost, is often overlooked. This refers to what you give up by choosing one option over another. For instance, if you spend time meditating, what could you be doing instead? These questions help ensure a balanced assessment of any intervention, much like how the FDA approaches drug trials, starting with assessing harm in phase one, followed by assessing benefits in phase two, and finally, confirming efficacy in phase three.
Weighing the benefits and costs of new technologies and treatments: Consider the potential benefits, opportunity cost, and risks of new technologies or treatments, especially when there's no clear evidence from RCTs, and prioritize activities with proven benefits like meditation, sleep, or exercise.
When considering the use of a new technology or treatment, it's important to weigh the potential benefits against the opportunity cost and potential risks. The speaker shares his experience with a relaxation device, which he found relaxing but questioned its value due to its high cost and the time commitment required for its prescribed use. He also points out that for many people, the opportunity cost of 40 minutes a day could be better spent on other activities with proven benefits, such as meditation, sleep, or exercise. He emphasizes that this thinking is especially important when there isn't clear evidence from randomized controlled trials (RCTs) to support the use of the technology or treatment. The speaker also mentions that RCTs are often easier to conduct for pharmacological interventions than for more complex interventions, and that considering the opportunity cost and potential risks is particularly relevant for such interventions. The speaker also raises the potential risk of anxiety or obsession with continuous glucose monitoring (CGM) for non-diabetics, and suggests that it may not be recommended for certain individuals, such as those with a history of eating disorders.
CGMs: Insights and Downsides for Diabetes Management: CGMs offer valuable insights for diabetes management, promoting behavior change, but their economic cost and potential for obsession are considerations.
Continuous Glucose Monitors (CGMs) can be beneficial for people with diabetes, but they also come with potential downsides. On the positive side, CGMs can provide valuable insights into carbohydrate tolerance and encourage behavior modification through increased self-awareness and accountability. However, the economic cost of these devices is a significant opportunity cost, making them inaccessible for many people without insurance coverage. The Hawthorne effect, where people modify their behavior simply because they are being observed, plays a role in the behavioral benefits of CGMs. But the potential for obsession and negative cycles around monitoring should also be considered. Ultimately, the decision to use a CGM should be made in consultation with a healthcare professional, taking into account individual circumstances and preferences.
Understanding the Value of Continuous Glucose Monitors: Continuous Glucose Monitors offer valuable insights into blood sugar levels, but their high cost may limit accessibility. They can be used periodically to make better food choices and manage health, with the most significant benefits gained in the first 30 days.
Continuous Glucose Monitors (CGMs) are an expensive yet valuable tool for managing blood sugar levels, with a rough estimate of $10 per day or approximately $3,500 per year. These devices, used by companies like Dexcom, Abbott, and Medtronic, can provide valuable insights into glucose levels, but they are not necessary to be worn every minute of every day. Instead, they can be used periodically to help individuals make better food choices and manage their health. The benefits of using CGMs can shift over time, with greater insights gained in the first 30 days and long-term behavioral changes. For instance, during college, the speaker used a food diary to identify their unhealthy habit of consuming a pint of Ben & Jerry's chocolate chip cookie dough daily. While CGMs can serve as a powerful motivational and behavioral tool, their high cost may limit accessibility for some individuals.
Understanding Diet and Blood Sugar Habits with Behavioral Tools: Food logs and CGM help gain insight into diet and blood sugar habits, leading to informed decisions and potential behavior change.
Behavioral tools, such as food logs and Continuous Glucose Monitors (CGM), can be effective in helping individuals understand and manage their habits, particularly when it comes to diet and blood sugar control. The speaker shares his personal experience of using a food log to break a Ben & Jerry's ice cream habit and how CGM provided valuable insights into the effect of different foods on his blood glucose levels. He emphasizes that the initial 90% of the experience is gaining insight, while the remaining 10% is behavior change. By the end of the trial period, individuals can expect to have a better understanding of how certain foods impact their body and make informed decisions based on that knowledge. The speaker also mentions that CGM is a valuable tool for managing diabetes and recommends a three-month trial for most patients.
Exclusive benefits for subscribers: Podcast offers discounts, member-only content, social media engagement, and healthcare professional consultation for subscribers
The Peter Atia MD podcast offers exclusive benefits for subscribers, including discount codes for trusted products, access to member-only content like Ask Me Anything sessions, and ongoing benefits. This is a great way for new listeners to explore past episodes and for existing members to maximize their experience. Subscribers can also engage with Dr. Atia on social media platforms like Twitter, Instagram, and Facebook, and leave reviews on their preferred podcast player. However, it's important to note that this podcast is for informational purposes only and does not constitute medical advice. Listeners should consult their healthcare professionals for any medical concerns. Dr. Atia also discloses any conflicts of interest and the companies he invests in or advises on his website. If you're already a member, make sure to download the member-only podcast feed for full access to subscriber benefits.