Objective Determination of Eating Occasion Timing: Combining Self-Report, Wrist Motion, and Continuous Glucose Monitoring to Detect Eating Occasions in Adults With Prediabetes and Obesity

• Published in: Journal of diabetes science and technology Vol. 18; no. 2; pp. 266 - 272
• Main Authors: Popp, Collin J., Wang, Chan, Hoover, Adam, Gomez, Louis A., Curran, Margaret, St-Jules, David E., Barua, Souptik, Sevick, Mary Ann, Kleinberg, Samantha
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.03.2024
• Subjects: Adult; Aged; Blood Glucose; Blood Glucose Self-Monitoring; Continuous Glucose Monitoring; Diabetes Mellitus, Type 2 - diagnosis; Female; Humans; Male; Middle Aged; Obesity - diagnosis; Prediabetic State - diagnosis; Self Report; Special Section: Algorithms for Predicting Complications of Diabetes; Wrist; meal detection; fasting; wearable sensors; intermittent fasting; meal timing; chrononutrition
• ISSN: 1932-2968; 1932-3107; 1932-3107
• DOI: 10.1177/19322968231197205

Background: Accurately identifying eating patterns, specifically the timing, frequency, and distribution of eating occasions (EOs), is important for assessing eating behaviors, especially for preventing and managing obesity and type 2 diabetes (T2D). However, existing methods to study EOs rely on self-report, which may be prone to misreporting and bias and has a high user burden. Therefore, objective methods are needed. Methods: We aim to compare EO timing using objective and subjective methods. Participants self-reported EO with a smartphone app (self-report [SR]), wore the ActiGraph GT9X on their dominant wrist, and wore a continuous glucose monitor (CGM, Abbott Libre Pro) for 10 days. EOs were detected from wrist motion (WM) using a motion-based classifier and from CGM using a simulation-based system. We described EO timing and explored how timing identified with WM and CGM compares with SR. Results: Participants (n = 39) were 59 ± 11 years old, mostly female (62%) and White (51%) with a body mass index (BMI) of 34.2 ± 4.7 kg/m2. All had prediabetes or moderately controlled T2D. The median time-of-day first EO (and interquartile range) for SR, WM, and CGM were 08:24 (07:00-09:59), 9:42 (07:46-12:26), and 06:55 (04:23-10:03), respectively. The median last EO for SR, WM, and CGM were 20:20 (16:50-21:42), 20:12 (18:30-21:41), and 21:43 (20:35-22:16), respectively. The overlap between SR and CGM was 55% to 80% of EO detected with tolerance periods of ±30, 60, and 120 minutes. The overlap between SR and WM was 52% to 65% EO detected with tolerance periods of ±30, 60, and 120 minutes. Conclusion: The continuous glucose monitor and WM detected overlapping but not identical meals and may provide complementary information to self-reported EO.