Quantification of personalized glycemic sensitivity to food and its potential for precision nutrition in a series of n-of-1 trials

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BACKGROUND: Uniform dietary guidelines ignore the fact that many healthy individuals, particularly those of Asian origin, display hyperglycemia after meals. A metric that assesses and quantifies differences in "glycemic sensitivity" between people may contribute to the prevention of type 2 diabetes. OBJECTIVES: We aimed to investigate the interpersonal variability in postprandial glycemic responses to identical meals and quantify the personalized glycemic sensitivity. METHODS: Using continuous glucose monitoring and standardized meals, we undertook a series of n-of-1 trials in 176 healthy Chinese participants (27.1 ± 3.7 y) in order to quantify differences in glycemic sensitivity and assess within-individual reproducibility. At the single-subject resolution, we created a novel metric (personalized glycemic sensitivity index, PGS) to quantify individual's glycemic sensitivity. The validity of the PGS was tested in a second independent study in a group of 30 individuals consuming alternate high and low-carbohydrate diets over 3 mo. RESULTS: As predicted, we observed a large variation in the degree of postprandial hyperglycemia between individuals but high consistency within individuals. Higher PGS is associated with larger daily glycemic fluctuations (linear regression parameter of the mean amplitude of glycemic excursions): 0.26 (95% confidence interval: 0.11, 0.41), and found to be reproducible over a 2-y interval (intraclass correlation coefficient analysis: 0.73). In the second study, PGS showed high temporal consistency (intraclass correlation coefficient analysis: 0.88). Notably, we also offer an application that integrates person-based PGS and food-specific glycemic indexes for creating personalized dietary libraries. CONCLUSIONS: Our novel PGS provides a framework for quantity differences in glycemic sensitivity among healthy individuals and facilitates further research on tailored dietary advice that improves glucose homeostasis. This trial was registered at clinicaltrials.gov as NCT05054153.

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