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The SCVC Blog

Cardiovascular care news and articles from our expert team

Metabolic Health Assessment

Posted on Sunday January 21, 2024 in Metabolic Health

Written by Dr Edward Leatham, Consultant Cardiologist

Even without abnormal readings of traditional markers of diabetes or pre-diabetic status, increased glucose variability (GV) in non diabetics is widely considered to be a 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 diagnosed using continuous glucose monitoring (CGM).

Our Metabolic Health Assessment provides a comprehensive review of an individual patient’s metabolism including glucose variability as well as traditional measures of inflammation and glucose homeostasis. 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, however 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 (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 Nutritional Therapist report and recommendations

What does it entail?

2 visits to SCVC and 10-14 days of monitoring, where a  daily log is kept by the patient.

Visit 1:  30 mins – our team will fit the CGM, install the Librelink App and explain how the assessment works.

Visit 2: Takes 2 hours at SCVC. Following a strict (water only) 8 hour fast, our nurse will take two blood samples, one at start and then one 2 hours after a 75 G glucose load (glucose tolerance test). The blood samples are sent to the lab for glucose and other markers to be measured. 

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

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

  •   BMI and targets
  •   Whether there is need for more detailed analysis of dietary intake and expert advice
  •   The use of self-help programmes such as https://www.veri.co/  that can be used to help monitor and improve their glycaemic control and overall health
  •   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 may find useful to understand and make lifestyle changes that will foster improved long-term outcomes.

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 either coaching using the Veri App (with or without Nutritional therapist coaching) or formal referral for a specialist opinion from either a Dietitian or Nutritional therapist.

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