Thread by @Gonzalez_JT

Should people be concerned with blood glucose concentrations if they don’t have prediabetes or diabetes?
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#glucose #health #biohack #science #metabolism #cgms #hba1c #sugarspikes

For context, the relationship between LDL-cholesterol concentration and coronary heart disease risk appears linear across the entire physiological range

What about glucose?
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For glucose, it might depend how it’s measured:

STANDARDISED TESTS (reflect underlying physiology)
-Fasting [glucose]
-2-h [glucose] post-OGTT

FREE-LIVING MEASURES (reflect underlying physiology x acute behaviour)
-HbA1c
-CGMS variables

What do the data show?
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Fasting glucose and mortality risk?

Little evidence that fasting [glucose] relates to risk of death in people without prediabetes or diabetes
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Fasting glucose and morbidity risk?

Little evidence that fasting [glucose] relates to cardiovascular disease in people without prediabetes or diabetes
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However, those whose [glucose] remains elevated above fasting, 2 h after 75 g oral glucose show higher mortality risk versus people whose [glucose] had returned to fasting.

Does this mean [glucose] matters?
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Possibly but not necessarily.

The OGTT reflects many aspects of physiology

It could be that other aspects of physiology are the causal link to mortality, [glucose] is just a marker.
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If glucose is causal, then it might be expected that free-living measures would also correlate with mortality or morbidity.

This is because the effect of physiology will be diluted by behaviour

So does HbA1c correlate with mortality?
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Little evidence that HbA1c correlates with mortality in people without prediabetes or diabetes (or CVD)

So should people without prediabetes or diabetes care about their glucose under free-living conditions?
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There may be some relevance of glucose within the non-diabetic range for some outcomes (e.g., physical activity, appetite etc.),

but its not yet clear that glucose in free-living conditions is important for hard outcomes of CVD or mortality
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