CONTINUOUS GLUCOSE MONITORING – A NOVEL TOOL FOR BEHAVIOUR CHANGE IN RELATIVE ENERGY DEFICIENCY IN SPORT (REDS)?

INTRODUCTION: Relative Energy Deficiency in Sport (REDs) is a multi-factorial clinical condition associated with profound adverse long-term health and performance consequences. The predominate treatment for REDs is to increase energy availability (EA) via increasing energy intake (EI), with the athlete understanding their own EA equation playing a key role in their recovery. However, knowledge alone may not be enough to create the required behaviour modifications around increasing EI and/or improving EA across the day. Yet, there is a dearth of evidence regarding behaviour change to increase EA in those with, or at risk of REDs. This descriptive qualitative study investigated the acceptability of continuous glucose monitoring (CGM) in athletes clinically diagnosed with REDs, and how biofeedback from CGM may play a role in creating the required behaviour change for the recovery of REDs.

METHODS: Females (n=8, 26.8 ± 6.4 years) with a diagnosis of REDs by an experienced medical specialist, participated in a seven-day trial whereby they wore an unblinded CGM sensor on their upper arm and were instructed to scan the sensor at least every eight hours. Participants were provided with only minimal information on what to expect in their glucose readings; no specific education was given as to how their glucose readings might reflect nutritional timing or choices. Participants also recorded their exercise data each day and their dietary intake for four days of the trial. A semi-structured interview guide was used to collect qualitative data to gain an understanding of the participants’ experience of wearing a CGM. Data were analysed using thematic analysis inductively for key themes.

RESULTS: Two main themes emerged from the data. The first theme, “Acceptable but aware”, captured the participants’ experience of wearing the CGM during their recovery of REDs. Participants found it easy to use, predominately unobtrusive, and showed low to no anxiety with regards to the continuous access to their interstitial glucose levels. The second theme, “Engagement with the data”, portrayed the spectrum to which participants connected with the CGM data and identified the potential of CGM to impact nutrition behaviour in the recovery of REDs, particularly in response to exercise.

DISCUSSION/CONCLUSION: The CGM appeared to provide an ‘objective permission’ to some participants to change their nutritional intake behaviours. This was predominately regarding fuelling before training, having linked their subjective feelings to the objective metrics on the CGM. However, there is a clear need to ensure individuals understand the CGM data, particularly around exercise, to be able to make meaningful change. CGMs do not appear to create anxiety in those diagnosed with REDs. With an accompanying education, CGM may have a potential role in creating behaviour change with regards to nutrition around exercise.