Can a stressful argument affect your blood sugar levels more than a piece of chocolate cake? It just might, as one participant of Sutter’s Metabolic Wellness Program discovered.
Stress matters; as do sleep, exercise, and of course, nutrition. In fact, these four lifestyle factors are the key levers in managing blood glucose levels.
This was just one of many insights had by participants of the novel 8-week program led by Ronesh Sinha, M.D., an internal medicine physician at the Palo Alto Medical Foundation. Launched on a small scale through PAMF in 2021, the Metabolic Wellness Program has since expanded to serve multiple cohorts a year, and over 350 people in a given cohort. Sutter Health employees, physicians in our medical group, Silicon Valley tech professionals, school teachers, transportation workers, stay-at-home parents, and retired people have all participated.
The Program’s goal is to help people use a Continuous Glucose Monitor – CGM - as a personal coach, offering data-driven motivation to keep up good habits and eliminate bad ones.
The CGM is a wearable device that has a dental floss-like filament that measures sugars levels in the user’s interstitial fluid (just above the blood). It pairs with a smartphone app that you can use to see glucose levels at any time, including glucose responses before and after a meal, exercise or stressful event; and during sleep-time. These continuous glucose levels are an important window into metabolic health, and when optimized, can prevent insulin resistance, type 2 and gestational diabetes, and cardio-metabolic disease.
“Continuous glucose monitoring has been a tool for insulin-dependent diabetics for a long time,” Dr. Sinha says. “But I have also been prescribing these devices as a lifestyle intervention for patients at risk for diabetes and those with type 2 diabetes who don’t require insulin.”
According to Dr. Sinha, by the time standard blood labs would detect any signs of trouble for a patient, it could be too late. “But now we can intervene years before people become even prediabetic,” he says. “Continuous glucose monitoring provides real-time feedback to help people make tailored changes to hopefully prevent diabetes or even reverse disease while improving how they feel physically and emotionally.”
One PAMF employee was blown away by what he discovered. He saw his glucose levels were spiking up to 324 mg/dL, and explained, “holy smokes, having access to the data in real time really slices through denial.” That individual lowered their A1C level by four points after just eight weeks in the program. Dr. Sinha says similar reactions are quite common among participants. “I can give general dietary advice and hope a patient makes changes, but it is the immediate feedback that provides the ‘aha’ moment for people,” he explains.
Knowledge Promotes Positive Action
By teaching Program participants about meaningful data patterns & target values; and lifestyle principles that can be tested for personal results; the Metabolic Wellness Program empowers them to make lifestyle choices that work for their situation. For instance, someone may discover they are actually exercising too much or not consuming enough calories, thereby under-fueling their body and entering a hypoglycemic state, which can make people feel poorly too.
“Does oatmeal actually spike your blood sugar?” Dr. Sinha poses. “Can exercise moderate the body’s response, making some foods acceptable for an individual?” These are the types of questions that continuous glucose monitoring can answer, often prompting big changes. “Knowing how my blood sugar interacts with my habits has completely changed everything for me—the way I’m eating, the way I’m exercising, everything,” says Raghu Raman, a technology professional in the Bay Area.
Making culturally sensitive recommendations for participants is also important, and it’s something that Dr. Sinha has spent most of his career doing for his patients. “We can’t ban rice from an Asian diet or put everyone on a Mediterranean diet to improve their health,” Dr. Sinha says. “But participants may see that cutting back on rice or exercising after meals can make an impact, showing them how their glucose responds within their own cultural framework.”
Beyond diet and exercise, this comprehensive look at individual metabolic responses provides other useful insights. For example, through traditional doctor visits it can be difficult to ascertain the impact of stress or sleep on blood glucose. But when one participant paired a sensor with a sleep-tracking device, they noted unstable levels while sleeping.
“Seeing the readout quantified the correlation between glucose and sleep,” Dr. Sinha says. “Once this person’s diet was stabilized, their nighttime glucose levels also stabilized. As a result, both the quantity and quality of their sleep improved, which can also improve general mood and outlook.”
The Metabolic Wellness Program also offers participants more than just a window into their own data. Training around data and lifestyle improvements are offered through a series of webinars led Dr Ron Sinha and Ms Prerna Uppal, RD; participants are sent weekly newsletters and offered member-only access to cutting edge content organized into an 8 week curriculum; and provided with support to find add-on services like holistic nutrition consults and specialty clinical care. Sutter’s Design and Innovation team created a digital platform to streamline onboarding of new participants, along with a web-portal for the Program’s rich online resources.
Serving a Broader Community
The successful pilots have demonstrated the immense benefit of the Metabolic Wellness Program and the need to expand it to serve more community members—especially following the COVID-19 crisis.
“During the pandemic, many people became disconnected from regular healthcare,” Dr. Sinha says. “But now I’m seeing programs like this get people excited about their health. They want more advice and more tools to take control of their health. This program has been a homerun for patients.”
Now, thanks to philanthropic funding through the PAMF Grants and Disbursements Program, the Metabolic Wellness Program will indeed expand further across Sutter Health to have greater impact.
Several groups throughout the system are working hard to make this happen, including the employer strategy team, which is looking at ways to broaden partnerships with companies. Workplaces beyond the Silicon Valley that have employees with prediabetes or high risk may soon be invited to join the Program.
Sutter Health’s Institute for Advancing Health Equity is also considering projects related to metabolic wellness. Launched in December 2020, IAHE looks closely at the social determinants of health and works to close gaps in care to improve the quality and access for at-risk populations. “A large body of research identifies the societal gaps that persist around diabetes—not just the heightened risk of disease but also the elevated consequences of diabetic retinopathy, loss of limbs and cardiovascular disease,” says Kristen Azar, R.N., BSN, MSN/MPH, scientific medical director of IAHE.
“We don’t want to reiterate the problem—we want to close gaps in care. If we can prove that continuous glucose monitoring makes a difference for high-risk populations, perhaps we can get monitors subsidized to give more patients access.”
Dr. Sinha and Azar agree that there is room for innovation in diabetes treatment, and both are excited to advance new tools that help patients think differently about their health.
The Metabolic Wellness Program also has implications for other medical specialists. Obstetricians, for instance, are seeing a dramatic rise in gestational diabetes. According to the Centers for Disease Control and Prevention, about 6% to 9% of pregnant women will develop gestational diabetes, with Asian and Hispanic women having the highest rates. With continuous glucose monitoring, expectant mothers could identify a potential problem earlier to help prevent this complication, which raises the risk of future diabetes and heart disease for both mother and baby.
Addressing another area of concern, insulin resistance, even without diabetes, is a risk factor for heart disease. Therefore, early lifestyle interventions such as continuous glucose monitoring could be useful in cardiovascular evaluations.
The ultimate benefit of monitoring tools is encouraging patients to be more engaged in their health. By understanding the patterns of their body, they may be more likely to practice preventive care—or any other necessary healthcare—before chronic disease takes root.