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The SCVC Blog

Cardiovascular care news and articles from our expert team

Metabolic Health Assessment

Posted on Monday May 27, 2024 in Metabolic Health

Written by Dr Edward Leatham, Consultant Cardiologist

The more we look, the more we find important, treatable yet unrecognised risk factors that may be important cause of our patients’ advancing coronary artery disease!

Coronary artery disease is an inflammatory condition which can start as early as in your 20s and certainly by 40 years of age it’s now possible to detect raised markers of coronary inflammation using CT based technique (known as ‘FAI’). From these data it’s clear that not everyone with raised coronary inflammation and elevated future risk of heart attack simply has a raised LDL Cholesterol- in fact there appears to be a mixed bag of risk factors associated with high coronary artery inflammation, including raised LDL, raised LP (a), raised Homocysteine, hypertension and dysregulated glucose.   Our metabolic health assessment is therefore designed to offer a comprehensive dive into known contributory causes, the latest and most controversial of which is ‘glucose dysregulation’, the principle topic of this article.

Even without abnormal readings of traditional markers of diabetes or pre-diabetic status, increased glucose variability (GV) and transiently raised blood glucose in non diabetics is widely considered to be a potentially important risk factor for:

  • Increased risk of developing diabetes or impaired glucose tolerance.
  • Increased systemic inflammation (caused by glycosylation and generation of free radicals) linked to arthritis and atherosclerosis.
  • Symptomatic low glucose post high glucose (due to insulin resistance and dumping ) causing daytime fatigue.
  • Future atherosclerotic heart and cerebrovascular disease including dementia and stroke.
  • (Possibly) premature ageing and wrinkles (glycosylation of collagen).
  • Increased BMI due to insulin resistance.

Increased glucose variability and glucose ‘spikes’ as defined by an abrupt change in blood glucose by >1.7 mmol/L, or >2 mg/dl/min and (by our own criteria) glucose values over 7.8 mmol/L and 10 mmol/L,  diagnosed using continuous glucose monitoring (CGM).

Our Metabolic Health Assessment provides a comprehensive review of an individual patient’s metabolism including lipoproteins, glucose variability, spikes and  traditional measures of inflammation and glucose homeostasis. Where glucose dysregulation is detected, we must remember that at present there is no hard evidence that flattening glucose curves or reducing glucose spikes has a significant impact on long term health, and historic negative interventional studies warn against over enthusiastic intervention. There is good circumstantial evidence that glucose spikes have detrimental effects,  so in those affected, dietary intervention,  under the direction of a  a qualified Dietitian or Nutritional therapist, seems a sensible next step for early adopters. 

The Metabolic Health Screen is available for patients that have a smartphone. Our top package includes the following:

  • MHA Registration form (App)
  • Continuous Glucose Monitor (Abbott Libre) fitted or assisted by our team
  • Daily CGM Log App installed with data processing to provide meaningful results
  • A Glucose Tolerance test (75 G Glucose challenge following an 8 hour overnight fast, Lab measured)
  • HbA1c, a marker of Red cell glycosylation (Lab measured)
  • Fasting blood glucose and Insulin (Lab measured)
  • Lymphocyte- Neutrophil Ratio LTN- a marker of oxidative stress
  • High sensitivity CRP, a marker of active inflammation
  • Advanced lipid profile, Apo lipoprotein B, LP (a), Homocysteine 
  • Expert report and recommendations

What if I already have my own CGM data?

From June 2024 we also offer an analysis only package for patients that have worn their own Freestyle Libre CGM and need advice and data processing to see how to respond to their results. This service is our MHA6 and involves completing a questionnaire online then sharing your CGM data so we can data process it and then have clinicians look at the results

What does MHA 1-5 entail?

1 visit to SCVC and 10-14 days of monitoring where a  daily log is kept by the patient.

The single visit will take  2 ½ hours following an 8 hour fast, where our team will take fasting bloods on arrival and give you a glucose drink, fit the CGM, install the Librelink App and explain how the assessment works.  2 hours later a post glucose blood test is repeated.

What is a Continuous Glucose Monitor or CGM?

Continuous glucose sugar monitor. Glucometer wireless transmitter. CGM device on patient’s skin. Measurement of blood glucose level. Vector illustration.

A small device the size of a 50 pence piece that sits on your skin and transits your internal glucose levels by sampling from a micro glucose sensor beneath the skin

During the period of monitoring lasting 10-14 days, glucose data is streamed via the patient’s’ own mobile device that is shared with the hosting clinic.  

Once collected, glucose and patient inputs are data processed (MedicalSpace ltd ) using advanced computations and AI, in order to present the results as a technical report – which will include:

  • Presence or absence of a pre-diabetes or diabetes
  • Daytime MAG – a recognised measure of glucose variability linked to future CHD and DM
  • Presence or absence of  glucose spikes > 7.8 mmol/L
  • Presence or absence of unhealthy (rapid, >2 mg/dl/min ) glucose spikes > 7.8 mmol/L (140 mg/dl)
  • Glucotype (normal, intermediate or severe GV)
  • Average daytime glucose
  • Proportion of awake time where glucose exceeds 7.8 mmol/L or is below 3.9 mmol/L
  • Comparisons to previous MHA results.

A table from a typical report showing CGM results, other examples can be viewed here.

As part of the assessment, the glucose data, activity, sleep and food diaries are reviewed by one of our team of doctors, dietitians and nutritional therapists, who provide written advice as part of the report, including:

  •   BMI, % body fat and targets
  •   Whether there is need for more detailed analysis of dietary intake and expert advice
  •   The use of self-help programmes such as  that can be used to help monitor and improve their glycaemic control.
  •   General changes to dietary intake that might improve metabolic health.

Where appropriate, our professionals can also provide links to useful websites and blog articles that patients with high GV or blood glucose spikes after meals may find useful to understand what lifestyle changes may be made that could lead to an improved long-term outcome.

The Metabolic Health Screen will not focus on all dietary intake nor provide advice on specific dietary patterns as it is not set up to collect intake information or resources for anything other than general advice to be issued as part of the report.   However, patients and their referring clinicians find the Metabolic Health Screen useful for establishing a diagnosis and triage ie  “have I got a problem”,  so your GP or physician, armed with our report, should be able to advise on whether additional measures are indicated (such as dedicated nutritional assessment, extra medication etc).

For patients that have unhealthy MHA results, we recommend that a second, simplified assessment is done about 12 weeks later to  assess the impact of lifestyle and diet changes that follow the first. In addition we can supply CGM with data processed results for patients that wish to monitor progress as they go themselves. For high risk cases we recommend  formal referral for a specialist opinion from either a Dietitian, Nutritional therapist or physician with specialist interest in this area. 

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