Fasting biochemical hypoglycemia and related-factors in non-diabetic population: Kanagawa Investigation of Total Check-up Data from National Database-8

Association between pre-exercise food ingestion timing and reactive hypoglycemia: Insights from a large database of continuous glucose monitoring data

Using a large database of continuous glucose monitoring (CGM) data, this study aimed to gain insights into the association between pre-exercise food ingestion timing and reactive hypoglycemia. A group of 6,761 users self-reported 48,799 pre-exercise food ingestion events and logged minute-by-minute CGM, which was used to detect reactive hypoglycemia (<70 mg/dL) in the first 30 min of exercise. A linear and a non-linear binomial logistic regression model was used to investigate the association between food ingestion timing and the probability of experiencing reactive hypoglycemia. An analysis of variance was conducted to compare the predictive ability of the models. On average, reactive hypoglycemia was detected in 8.34 ± 3.04% of the total events, with <15% of individuals experiencing hypoglycemia in >20% of their events. The majority of the reactive hypoglycemia events were found with pre-exercise food timing between ∼30 and ∼90 min, with a peak at ∼60 min. The superior accuracy (62.05 vs 45.1%) and F-score (0.75 vs 0.59) of the non-linear vs the linear model were statistically superior (P < 0.0001). These results support the notion of an unfavourable 30-to-90 min pre-exercise food ingestion time window which can significantly impact the likelihood of reactive hypoglycemia in some individuals.

Continuous glucose monitoring for detection of glycemic variability, hypoglycemia, and hyperglycemia in women with eating disorders

Background

The aim of this study was to investigate the relationships between hypoglycemia, hyperglycemia, glycemic variability (GV), and eating behavior by measuring daily glucose levels through an intermittently scanned continuous glucose monitoring (isCGM) system in outpatients classified according to eating disorder subtypes.

Methods

We analyzed data for 18 patients (four ANR, nine ANBP, and five BN cases). A FreeStyle Libre Pro® device was attached to the posterior aspect of the upper arm for glucose monitoring. This device conducted measurements every 15 min for five consecutive days. We estimated the mean amplitude of glycemic excursions (MAGE), hypoglycemia, and hyperglycemia.

Results

The mean glucose levels were 91.1 ± 2.2 mg/dL in the ANR group, 94.8 ± 7.5 mg/dL in the ANBP group, and 87.1 ± 8.0 mg/dL in the BN group (P = 0.174). The overall mean MAGE index was 52.8 ± 20.5 mg/dL. The mean MAGE values according to the subtypes were 42.2 ± 5.6 mg/dL in the ANR group, 57.4 ± 23.7 mg/dL in the ANBP group, and 53.0 ± 21.8 mg/dL in the BN group (P = 0.496). Over the course of five days, the frequency of hypoglycemia was as follows: three occurrences in the ANBP group, five occurrences in the BN group, and no occurrences in the ANR group (P = 0.016). Moreover, the occurrence of hypoglycemia was statistically significantly higher in the BN group than in the ANR group (P = 0.013). In the BN group, the frequency of hypoglycemia was highest between 2 and 6 AM, while hypoglycemia was observed throughout the day in the ANBP group. The frequency of hyperglycemia was one occurrence in the ANR group, one occurrence in the BN group, and zero occurrences in the ANBP group (P = 0.641).

Conclusions

Varying GV, hypoglycemia, and hyperglycemia were observed in all subtypes of eating disorders. Our findings suggest that eating behaviors such as binge eating and purging are associated with GV and hypoglycemia. We showed the importance of developing different nutritional approaches tailored to the subtype of eating disorder to prevent hypoglycemia. Additional studies are needed to explore the relationship between glucose levels and eating behaviors in patients with eating disorders.