Thread by @DaveKeto

1/ This tweet below from @DBelardoMD brought a lot of interesting conversation.

I wasn't going to weigh in, but given I'm pretty vocal on this topic already, here are some respectful additions...

https://twitter.com/DBelardoMD/status/1404455546338619393

2/ First, I agree glucose going up and down -- in and of itself -- is not inherently a mechanism of concern.

The key questions of interest are by how much and for how long -- and from this, can we determine if there is a dysregulation?

3/ I was listening earlier in a Clubhouse chat to @Dr__Guess discuss her recent study and how "all over the map" glucose levels were for these T2D patients -- which is unsurprising given the nature of the disease.

https://twitter.com/DaveKeto/status/1404964159536570369?s=20

4/ I think most would agree there's likely a spectrum to T2D for many (if not most) people. Which is to say, progressive onset of T2D may be detectable where one is showing small signs of dysregulation before larger ones. Yes, much debate on exactly how we "get" to T2D...

5/ But there isn't much debate on the dysregulation itself -- hence the OGTT test being considered the gold standard (tho I'd argue the true gold standard is matching it alongside insulin testing per Kraft)

Having a CGM is, in a sense, like having an "always on" OGTT running.

6/ However, you don't need a CGM if you're willing to simply test your blood at the intervals intended with an over the counter glucometer.

That said, from my own experience with a CGM, there can still be a lot of variability depending on the meal, time of day, sleep, etc

7/ And that's the part that I think gets missed in this conversation between the two "sides":

Whether I were on a low or high carb diet, I do care if my postprandial glucose climbs to levels north of 140 and/or lingers at a high range for longer than 2 hours on a per meal basis

8/ I learned a lot of things were higher glycemic than I thought and could have only known due to the CGM.

I've never been diagnosed as full T2D (A1c only to 6.1 before heading back via #keto)

9/ Again, I know many, many people on high carb diets who handle carbs quite well, IMO

But would those same people find it curious if one particular meal had an unusual spike in glucose followed by a sustained level for many hours in a given circumstance and/or meal? I think so

10/ And it's those potential opportunities for course correction that I suspect could be very valuable in avoiding an onset of T2D.

That's why coming non-invasive wearables (fingers crossed, Apple Watch) could truly change the landscape, IMO.

11/ To be fair, it's certainly speculative given we don't have long term studies on non-diabetics (per @DBelardoMD's point). But definitely put me on the record for betting it will be a net gain overall -- particularly when we have the non-invasive wearables making it easier.