{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T12:03:31Z","timestamp":1777896211022,"version":"3.51.4"},"reference-count":44,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2024,1,24]],"date-time":"2024-01-24T00:00:00Z","timestamp":1706054400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>The use of continuous glucose monitors (CGMs) in individuals living without diabetes is increasing. The purpose of this study was to profile various CGM metrics around nutritional intake, sleep and exercise in a large cohort of physically active men and women living without any known metabolic disease diagnosis to better understand the normative glycemic response to these common stimuli. A total of 12,504 physically active adults (age 40 \u00b1 11 years, BMI 23.8 \u00b1 3.6 kg\/m2; 23% self-identified as women) wore a real-time CGM (Abbott Libre Sense Sport Glucose Biosensor, Abbott, USA) and used a smartphone application (Supersapiens Inc., Atlanta, GA, USA) to log meals, sleep and exercise activities. A total of &gt;1 M exercise events and 274,344 meal events were analyzed. A majority of participants (85%) presented an overall (24 h) average glucose profile between 90 and 110 mg\/dL, with the highest glucose levels associated with meals and exercise and the lowest glucose levels associated with sleep. Men had higher mean 24 h glucose levels than women (24 h\u2014men: 100 \u00b1 11 mg\/dL, women: 96 \u00b1 10 mg\/dL). During exercise, the % time above &gt;140 mg\/dL was 10.3 \u00b1 16.7%, while the % time &lt;70 mg\/dL was 11.9 \u00b1 11.6%, with the remaining % within the so-called glycemic tight target range (70\u2013140 mg\/dL). Average glycemia was also lower for females during exercise and sleep events (p &lt; 0.001). Overall, we see small differences in glucose trends during activity and sleep in females as compared to males and higher levels of both TAR and TBR when these active individuals are undertaking or competing in endurance exercise training and\/or competitive events.<\/jats:p>","DOI":"10.3390\/s24030744","type":"journal-article","created":{"date-parts":[[2024,1,24]],"date-time":"2024-01-24T09:57:42Z","timestamp":1706090262000},"page":"744","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Real World Interstitial Glucose Profiles of a Large Cohort of Physically Active Men and Women"],"prefix":"10.3390","volume":"24","author":[{"given":"Kristina","family":"Skroce","sequence":"first","affiliation":[{"name":"Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia"},{"name":"Supersapiens Inc., Atlanta, GA 30318, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1315-5573","authenticated-orcid":false,"given":"Andrea","family":"Zignoli","sequence":"additional","affiliation":[{"name":"Supersapiens Inc., Atlanta, GA 30318, USA"},{"name":"Department of Industrial Engineering, University of Trento, 38123 Trento, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federico Y.","family":"Fontana","sequence":"additional","affiliation":[{"name":"Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism (UDEM), Bern University Hospital, University of Bern, 3010 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4221-6104","authenticated-orcid":false,"given":"Felipe M.","family":"Maturana","sequence":"additional","affiliation":[{"name":"Sports Medicine Department, University Hospital of T\u00fcbingen, 72076 T\u00fcbingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3443-2023","authenticated-orcid":false,"given":"David","family":"Lipman","sequence":"additional","affiliation":[{"name":"Supersapiens Inc., Atlanta, GA 30318, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Tryfonos","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Division of Clinical Physiology, Karolinska Institute, 171 77 Stockholm, Sweden"},{"name":"School of Science, Department of Life Science, European University Cyprus, Nicosia 1516, Cyprus"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6556-7559","authenticated-orcid":false,"given":"Michael C.","family":"Riddell","sequence":"additional","affiliation":[{"name":"School of Kinesiology and Health Science, Muscle Health Research Centre, York University, Toronto, ON M3J 1P3, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Howard C.","family":"Zisser","sequence":"additional","affiliation":[{"name":"Supersapiens Inc., Atlanta, GA 30318, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,1,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Brooks, G.A. (2020). The Precious Few Grams of Glucose During Exercise. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21165733"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"E11","DOI":"10.1152\/ajpendo.90563.2008","article-title":"Four Grams of Glucose","volume":"296","author":"Wasserman","year":"2009","journal-title":"Am. J. Physiol.-Endocrinol. Metab."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1778","DOI":"10.1001\/jama.1924.02650480034015","article-title":"Some Changes in the Chemical Constituents of the Blood Following a Marathon Race","volume":"82","author":"Levine","year":"1924","journal-title":"J. Am. Med. Assoc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"446","DOI":"10.2165\/00007256-198401060-00004","article-title":"Effectiveness of Carbohydrate Feeding in Delaying Fatigue during Prolonged Exercise","volume":"1","author":"Coyle","year":"1984","journal-title":"Sports Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/s12970-017-0189-4","article-title":"International Society of Sports Nutrition Position Stand: Nutrient Timing","volume":"14","author":"Kerksick","year":"2017","journal-title":"J. Int. Soc. Sports Nutr."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1123\/ijsnem.2016-0316","article-title":"A Mismatch Between Athlete Practice and Current Sports Nutrition Guidelines Among Elite Female and Male Middle- and Long-Distance Athletes","volume":"27","author":"Heikura","year":"2017","journal-title":"Int. J. Sport Nutr. Exerc. Metab."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/j.diabres.2017.08.005","article-title":"Continuous Glucose Monitoring: A Review of the Technology and Clinical Use","volume":"133","author":"Klonoff","year":"2017","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2501","DOI":"10.1007\/s00125-020-05263-9","article-title":"Glucose Management for Exercise Using Continuous Glucose Monitoring (CGM) and Intermittently Scanned CGM (IsCGM) Systems in Type 1 Diabetes: Position Statement of the European Association for the Study of Diabetes (EASD) and of the International Society for Pediatric and Adolescent Diabetes (ISPAD) Endorsed by JDRF and Supported by the American Diabetes Association (ADA)","volume":"63","author":"Moser","year":"2020","journal-title":"Diabetologia"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Ishihara, K., Uchiyama, N., Kizaki, S., Mori, E., Nonaka, T., and Oneda, H. (2020). Application of Continuous Glucose Monitoring for Assessment of Individual Carbohydrate Requirement during Ultramarathon Race. Nutrients, 12.","DOI":"10.3390\/nu12041121"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2304","DOI":"10.1113\/EP088188","article-title":"Nutritional Approaches to Counter Performance Constraints in High-level Sports Competition","volume":"106","author":"Burke","year":"2021","journal-title":"Exp. Physiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1089\/dia.2014.0272","article-title":"Assessing Sensor Accuracy for Non-Adjunct Use of Continuous Glucose Monitoring","volume":"17","author":"Kovatchev","year":"2015","journal-title":"Diabetes Technol. Ther."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/S2213-8587(22)00319-9","article-title":"Continuous Glucose Monitoring and Metrics for Clinical Trials: An International Consensus Statement","volume":"11","author":"Battelino","year":"2023","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1187\/cbe.13-04-0082","article-title":"The Other Half of the Story: Effect Size Analysis in Quantitative Research","volume":"12","author":"Maher","year":"2013","journal-title":"CBE\u2014Life Sci. Educ."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1177\/1932296820905904","article-title":"Effect of Exercise and Meals on Continuous Glucose Monitor Data in Healthy Individuals Without Diabetes","volume":"15","author":"DuBose","year":"2021","journal-title":"J. Diabetes Sci. Technol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1038\/s41746-023-00956-y","article-title":"Digital Health Application Integrating Wearable Data and Behavioral Patterns Improves Metabolic Health","volume":"6","author":"Zahedani","year":"2023","journal-title":"NPJ Digit. Med."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Hall, H., Perelman, D., Breschi, A., Limcaoco, P., Kellogg, R., McLaughlin, T., and Snyder, M. (2018). Glucotypes Reveal New Patterns of Glucose Dysregulation. PLoS Biol., 16.","DOI":"10.1371\/journal.pbio.2005143"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"13987","DOI":"10.1038\/s41598-023-40949-1","article-title":"Reproducibility of Continuous Glucose Monitoring Results under Real-Life Conditions in an Adult Population: A Functional Data Analysis","volume":"13","author":"Matabuena","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"D\u2019Souza, N.C., Kesibi, D., Yeung, C., Shakeri, D., D\u2019Souza, A.I., Macpherson, A.K., and Riddell, M.C. (2023). The Impact of Sex, Body Mass Index, Age, Exercise Type and Exercise Duration on Interstitial Glucose Levels during Exercise. Sensors, 23.","DOI":"10.3390\/s23229059"},{"key":"ref_19","unstructured":"Sprague, J.E., and Arbel\u00e1ez, A.M. (2011). Glucose Counterregulatory Responses to Hypoglycemia. Pediatr. Endocrinol. Rev., 9."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1152\/jappl.1977.43.4.695","article-title":"Effects of Elevated Plasma FFA and Insulin on Muscle Glycogen Usage during Exercise","volume":"43","author":"Costill","year":"1977","journal-title":"J. Appl. Physiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"S68","DOI":"10.1055\/s-2007-1024956","article-title":"Effect of Carbohydrate Intake During Warming-up on the Regulation of Blood Glucose During Exercise","volume":"10","author":"Brouns","year":"1989","journal-title":"Int. J. Sports Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1123\/ijsnem.12.4.398","article-title":"Prevalence of Hypoglycemia Following Pre-Exercise Carbohydrate Ingestion Is Not Accompanied by Higher Insulin Sensitivity","volume":"12","author":"Jentjens","year":"2002","journal-title":"Int. J. Sport Nutr. Exerc. Metab."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1007\/s00421-002-0730-1","article-title":"Effects of Pre-Exercise Ingestion of Carbohydrate on Glycaemic and Insulinaemic Responses during Subsequent Exercise at Differing Intensities","volume":"88","author":"Achten","year":"2003","journal-title":"Eur. J. Appl. Physiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1159\/000322698","article-title":"The Myths Surrounding Pre-Exercise Carbohydrate Feeding","volume":"57","author":"Jeukendrup","year":"2010","journal-title":"Ann. Nutr. Metab."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2340","DOI":"10.1080\/17461391.2023.2233468","article-title":"Association between Pre-Exercise Food Ingestion Timing and Reactive Hypoglycemia: Insights from a Large Database of Continuous Glucose Monitoring Data","volume":"23","author":"Zignoli","year":"2023","journal-title":"Eur. J. Sport Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"4356","DOI":"10.1210\/jc.2018-02763","article-title":"Continuous Glucose Monitoring Profiles in Healthy Nondiabetic Participants: A Multicenter Prospective Study","volume":"104","author":"Shah","year":"2019","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1123\/ijsnem.20.4.299","article-title":"Race-Day Carbohydrate Intakes of Elite Triathletes Contesting Olympic-Distance Triathlon Events","volume":"20","author":"Cox","year":"2010","journal-title":"Int. J. Sport Nutr. Exerc. Metab."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1123\/ijsn.7.1.61","article-title":"Increased Energy and Nutrient Intake during Training and Competition Improves Elite Triathletes\u2019 Endurance Performance","volume":"7","author":"Frentsos","year":"1997","journal-title":"Int. J. Sport Nutr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"862396","DOI":"10.3389\/fnut.2022.862396","article-title":"Carbohydrate Intake Practices and Determinants of Food Choices During Training in Recreational, Amateur, and Professional Endurance Athletes: A Survey Analysis","volume":"9","author":"Reinhard","year":"2022","journal-title":"Front. Nutr."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"113","DOI":"10.2147\/DMSO.S29222","article-title":"The Impact of Brief High-Intensity Exercise on Blood Glucose Levels","volume":"2013","author":"Adams","year":"2013","journal-title":"Diabetes Metab. Syndr. Obes."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Gordon, B.A., Taylor, C.J., Church, J.E., and Cousins, S.D. (2021). A Comparison of the Gluco-Regulatory Responses to High-Intensity Interval Exercise and Resistance Exercise. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18010287"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.diabres.2019.03.038","article-title":"Assessment of Glucose Variability in Subjects with Prediabetes","volume":"151","author":"Chakarova","year":"2019","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1150","DOI":"10.2337\/diab.33.12.1150","article-title":"Demonstration of a Dawn Phenomenon in Normal Human Volunteers","volume":"33","author":"Bolli","year":"1984","journal-title":"Diabetes"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1159\/000181791","article-title":"Demonstration of a Dawn Phenomenon in Normal Adolescents","volume":"34","author":"Arslanian","year":"1990","journal-title":"Horm. Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"32","DOI":"10.2337\/diacare.7.1.32","article-title":"Fasting Early Morning Rise in Peripheral Insulin: Evidence of the Dawn Phenomenon in Nondiabetes","volume":"7","author":"Schmidt","year":"1984","journal-title":"Diabetes Care"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"E246","DOI":"10.1152\/ajpendo.1996.271.2.E246","article-title":"Evidence for a Circadian Rhythm of Insulin Secretion","volume":"271","author":"Boden","year":"1996","journal-title":"Am. J. Physiol.-Endocrinol. Metab."},{"key":"ref_37","first-page":"716","article-title":"Roles of Circadian Rhythmicity and Sleep in Human Glucose Regulation","volume":"18","author":"Polonsky","year":"1997","journal-title":"Endocr. Rev."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"100545","DOI":"10.1016\/j.crmeth.2023.100545","article-title":"Uncovering Personalized Glucose Responses and Circadian Rhythms from Multiple Wearable Biosensors with Bayesian Dynamical Modeling","volume":"3","author":"Phillips","year":"2023","journal-title":"Cell Rep. Methods"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"S91","DOI":"10.1080\/02640414.2011.610348","article-title":"Nutrition for Endurance Sports: Marathon, Triathlon, and Road Cycling","volume":"29","author":"Jeukendrup","year":"2011","journal-title":"J. Sports Sci."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.2337\/dc09-0076","article-title":"Reference Values for Continuous Glucose Monitoring in Chinese Subjects","volume":"32","author":"Zhou","year":"2009","journal-title":"Diabetes Care"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"31","DOI":"10.2337\/diab.44.1.31","article-title":"Gender and Insulin Sensitivity in the Heart and in Skeletal Muscles: Studies Using Positron Emission Tomography","volume":"44","author":"Nuutila","year":"1995","journal-title":"Diabetes"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"195","DOI":"10.3389\/fendo.2014.00195","article-title":"Gender Differences in Skeletal Muscle Substrate Metabolism\u2014Molecular Mechanisms and Insulin Sensitivity","volume":"5","author":"Lundsgaard","year":"2014","journal-title":"Front. Endocrinol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1113\/JP279499","article-title":"Physiological and Molecular Sex Differences in Human Skeletal Muscle in Response to Exercise Training","volume":"601","author":"Landen","year":"2023","journal-title":"J. Physiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1177\/0972558X19835371","article-title":"Blood Glucose Levels at Two Different Phases of Menstrual Cycle: A Study on a Group of Bengali-Speaking Hindu Ethnic Populations of West Bengal, India","volume":"19","author":"Dey","year":"2019","journal-title":"Orient. Anthropol. Bi-Annu. Int. J. Sci. 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