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Monitoring blood sugar levels used to be something only people with diabetes did. But in recent years, glucose monitoring has quickly become one of the trendiest biometrics to track for people striving to optimize their health. There are companies that claim that wearing a continuous glucose monitoring device can improve metabolic health, promote weight loss and establish healthy eating habits in people without diabetes. But- does the research back up their claims? Keep reading to find out.
Why is monitoring glucose important?
Blood glucose monitoring is particularly important for people with diabetes to determine whether their current treatment plan is effective. Regularly checking blood glucose levels allows individuals with diabetes to make timely adjustments and informed decisions in order to maximize the amount of time their blood glucose levels are within a target range, reducing the amount of time glucose levels are too high or too low.
People with diabetes often check their blood sugar at least 4-6 times per day, but the development of CGM technology has eliminated the need for fingersticks for many people with diabetes. CGM users now have the convenience of receiving updated glucose readings every 5 minutes, along with alerts for high or low blood sugar levels. Monitoring glucose levels is crucial for individuals with diabetes as it helps prevent blood sugar levels from reaching dangerously high or low levels. When blood glucose levels are effectively managed, it can reduce the risks associated with diabetes and enhance overall quality of life.
Why would someone without diabetes want to wear a CGM?
Monitoring blood sugar levels has become increasingly popular among individuals without diabetes in recent years. Although typically associated with diabetes management, people without diabetes may choose to monitor their blood sugar for various reasons. Some individuals see it as a means of optimizing their overall health by gaining insights into how their body responds to different factors such as food choices, exercise, and stress.
In the United States and Canada, CGMs require a medical prescription and are only approved for use for individuals with diabetes. In recent years, several digital health companies have been targeting the use of CGMs to improve general health by assisting individuals with making lifestyle changes. These companies employ doctors to prescribe CGMs for off-label use and users will pay out-of-pocket for these devices. At this time, there is limited research in regards to the benefit of CGMs for generally healthy people without diabetes. However, it is a subject of growing interest in research making it worth exploring the common patient populations who may benefit from their use.
CGMs for behavior change without diabetes
Digital health companies commonly market CGMs as a tool for assisting individuals without diabetes for making behavior changes to optimize their overall health. These companies claim that tracking blood sugar levels can provide insights into how their body responds to different foods, exercise, stress and other lifestyle factors. It is thought that by receiving real-time feedback about different lifestyle factors, individuals can make more informed choices that promote better health.
In some instances, CGM use may not be completely necessary. According to a study from 2019 that compared individuals using a finger prick to CGM users, it concluded that either method of measuring glucose can be an effective tool for learning to eat based on pre-meal glucose levels. Additionally, there were no differences between the groups in terms of intervention acceptability, weight, body composition, HbA1C, eating behaviors or psychological health.
CGMs for chronic disease management
A common motivation behind people without diabetes wearing CGMs is to improve their glucose patterns to reduce their risk of prediabetes or diabetes. Currently, diagnostic criteria for prediabetes or diabetes includes HbA1C, fasting glucose, or two-hour glucose concentration. These laboratory tests may miss early signs of prediabetes or diabetes. CGMs may be able to provide additional diagnostic information and potentially facilitate an early diagnosis and treatment for people with prediabetes or those at an increased risk of developing type 2 diabetes.
While early detection of prediabetes with the use of CGMs seems promising, there is limited research evidence that supports what glucose fluctuations put people at increased risk of prediabetes or diabetes and how often diabetes can be prevented or delayed. Future research is expected to address these gaps and establish comprehensive guidelines on the use of CGMs for early detection of prediabetes.
CGMs for curiosity and control
Some individuals choose to wear a CGM out of curiosity regarding their blood sugar levels and body functioning. While this might appear harmless, monitoring blood sugar without medical necessity could result in unnecessary concern or misinterpretation of the results. CGM metrics were originally developed for individuals with diabetes. Currently, there are no standardized guidelines for what is considered normal glucose fluctuations in people without diabetes.
According to an article on Healio featuring Dr. Viral N. Shah, using these metrics to assess health status or changes in health status is not appropriate for people without diabetes. Dr. Shah conducted a study in 2023 which revealed that the mean GMI (Glucose Management Indicator) was 0.59% higher than the laboratory HbA1C measurement in participants without diabetes, and 71% of participants experienced a difference of more than 0.4% between GMI and HbA1C readings. The reported higher CGM-derived data compared to laboratory A1C measurements may lead to unnecessary stress or misinterpretation of results for CGM users without diabetes. Individuals who choose to utilize a CGM without diabetes should take caution when interrupting their CGM results, until definitive guidelines are established for interpreting CGM data in individuals without diabetes, It is advised to maintain routine laboratory blood tests in conjunction with CGM use.
Can people without diabetes benefit from wearing a CGM?
Although the existing research of the benefits of wearing a CGM for generally healthy people with diabetes is scarce, there are several specific populations that have been researched and shown promising benefits of its use. Some of these groups include premature infants, individuals experiencing steroid-induced hyperglycemia, and individuals in intensive care or post-surgical settings.
CGMs for premature infants
Hypoglycemia, which refers to low blood sugar levels, is a common and persistent occurrence in premature infants. CGMs have the potential to reduce the frequency and severity of low blood sugar episodes in preterm infants by providing real-time glucose trend reports, which can result in more proactive management. Current strategies for glucose monitoring rely on intermittent blood glucose readings which leaves prolonged periods between glucose measurements. Currently, there are some hospital systems who have already adopted the use of CGMs for neonatal care, but there are practical limitations since these devices are not designed for neonatal use. As CGM device technology continues to evolve with smaller sensors, quicker warm up periods, improved accuracy and no need for calibration, there may be increased adoption of CGM use for neonatal care.
CGM use for steroid-induced hyperglycemia
Steroid therapy is a commonly used approach for treating various inflammatory conditions. When individuals without diabetes receive steroid treatment, it can lead to a condition known as steroid-induced hyperglycemia. This condition is associated with prolonged hospital stays, increased susceptibility to infections, and even mortality. In clinical practice, glucose monitoring for patients experiencing steroid-induced hyperglycemia is typically conducted four times a day, before each meal and before bedtime. However, an intermittent approach to glucose monitoring may not provide sufficient information to accurately assess the extent of elevated blood sugar levels. The use of CGMs could potentially enhance and simplify the care provided to patients undergoing steroid therapy since CGMs offer real-time monitoring of glucose levels. CGM devices provide valuable insights into glucose patterns throughout the day which may prompt earlier interventions and treatments to improve glucose levels.
CGM use in intensive care unit
The use of CGMs in intensive care units (ICUs) can allow healthcare professionals to closely monitor and manage glucose levels in critically ill patients. Maintaining tight glucose control in this population is crucial as abnormal blood glucose levels are associated with adverse outcomes, including increased morbidity and mortality. Currently, blood glucose monitoring in ICUs relies on intermittent glucose readings, which may not capture the frequency of hypo- and hyperglycemia episodes.
The implementation of CGMs in the ICU may face challenges related-to sensor accuracy, calibration, and potential interference from medications or physiological variables. To fully leverage the adoption of CGMs in the ICU setting, further research and technological advancements are essential to establish best practices and guidelines to optimize the use and enhance patient care outcomes.
CGM use for athletic performance
CGM technology has recently gained attention as a potential tool for optimizing athletic performance. Understanding how glucose levels change throughout different activities, such as endurance training, high-intensity workouts, and recovery periods, could assist athletes with fine-tuning their nutrition and hydration strategies to improve endurance, energy levels and overall performance. The use of CGM for athletic performance is still an emerging area and more research is needed to fully understand the potential benefits and limitations. There are currently no standardized guidelines for glucose levels that are associated with peak performance. As with any new technology, athletes should work closely with healthcare professionals and sports nutrition experts to interpret CGM data effectively and develop personalized strategies to optimize performance based on their unique needs and goals.
Potential Drawbacks of CGM use without diabetes
While CGMs have been proven to be beneficial technology for people with diabetes, there are potential drawbacks to its use in individuals without diabetes. Here are a few considerations:
- Inaccuracy: CGMs are primarily designed and calibrated for individuals with diabetes. When used in individuals without diabetes, the accuracy of CGM readings may vary. Factors such as physiological differences and variations in glucose metabolism can affect the reliability of CGM measurements, leading to potential inaccuracies in glucose readings.
- Interpretation challenges: Interpreting CGM data and glucose trends can be complex, especially for individuals who are not specialized in diabetes management. Without the proper knowledge and understanding of glucose patterns, it may be challenging to make appropriate lifestyle changes based on the CGM data alone.
- Unnecessary interventions: CGMs provide real-time data of glucose readings which can lead to excessive concern and unnecessary interventions over insignificant changes in glucose levels.
- Cost and resource utilization: CGMs can be expensive, and using them in individuals without diabetes may lead to unnecessary healthcare expenditures. Additionally, CGM requires regular calibration and sensor replacement, which can further contribute to costs and resource utilization.
- Psychological impact: CGMs can cause anxiety and stress from the constant access of glucose levels. Some individuals may become overly focused on CGM readings and mistakenly interpret minor glucose fluctuations as signs of health problems.
It's important to note that using CGM in individuals without diabetes is an emerging area of research, and further studies are needed to understand its benefits, limitations, and appropriate applications for people without diabetes.
Important Glucose Metrics to Track
Blood sugar can be an important health metric to track for people with and without diabetes. While CGMs represent just one available tool for measuring blood glucose levels, there are several alternatives that are more cost-effective and easier to obtain. These include:
- Glucometers: a handheld device that measures glucose levels using a small sample of blood via a finger prick. While glucometers may be less convenient than a CGM, they still provide almost instant feedback on blood glucose levels at any given moment and are relatively affordable in comparison to CGMs. Typically, any blood glucose reading greater than or equal to 200 mg/dL may indicate diabetes.
- Fasting plasma glucose: this blood test is usually done first thing in the morning, before breakfast or after at least 8 hours of fasting. Diabetes can often be diagnosed at fasting blood glucose of greater than or equal to 126 mg/dl
- Hemoglobin A1C: a blood test measures your average blood glucose for the past two to three months. The advantages of being diagnosed this way are that you don't have to fast or drink anything. Diabetes is typically diagnosed at an A1C of greater than or equal to 6.5%
- Oral Glucose Tolerance: typically conducted during pregnancy to assess how well your body is processing sugar. It is a two-hour test that checks your blood glucose levels before and two hours after you drink a special sweet drink. If blood glucose levels are greater than 200 mg/dL after two hours, it may indicate diabetes.
People without diabetes who are curious or concerned about their glucose levels are encouraged to speak to their doctor or healthcare provider about which lab tests are right for them.
The bottom line
With the rising popularity of digital health programs, CGMs have become part of the latest trend in health monitoring and an increasingly popular area of research. Although there is limited data on the benefits of CGM for people without diabetes, it is anticipated that future research will provide valuable insights into the specific role of CGM use as well as consensus guidelines on how to interpret and respond to glucose data for this population. As research in this area advances, the potential benefits of CGM use will likely be better understood as a valuable tool for health monitoring beyond diabetes management.