With little evidence, CGM benefits for people without diabetes ‘largely hypothetical’
Click Here to Manage Email Alerts
Key takeaways:
- Data show some benefits with continuous glucose monitoring (CGM) for all types of diabetes.
- There is much less well-conducted research on CGM for those with prediabetes or obesity without diabetes.
BOSTON — Continuous glucose monitoring is becoming a mainstay of care for people with type 1 and type 2 diabetes, yet providers should be cautious about the technology’s application for people without diabetes looking for a “wellness” tool.
A growing body of evidence now demonstrates the benefits of continuous glucose monitoring (CGM) for people with type 1 diabetes, insulin-using type 2 diabetes and those with high-risk hypoglycemia, and early data show benefit for those with non-insulin using type 2 diabetes, Athena Philis-Tsimikas, MD, a specialist in endocrinology, diabetes and metabolism and corporate vice president of the Scripps Whittier Diabetes Institute at Scripps Health, said during a presentation at the Cardiometabolic Health Congress. Emerging data also show the potential use of CGM for people with prediabetes, especially those with an HbA1c of 6% or higher, and those with gestational diabetes.
Image: Adobe Stock
Yet, despite hype from some companies offering CGM as a way for people without diabetes to monitor glucose to address or prevent a host of conditions, there are little to no data on CGM for weight loss or lifestyle management, Philis-Tsimikas said.
“CGM has significant potential for lifestyle and therapeutic benefit in people with type 1 and type 2 diabetes — both insulin and non-insulin using — and the body of evidence is slowly growing,” Philis-Tsimikas told Healio. “There is much less information or well-conducted research for prediabetes and even less for individuals without diabetes or prediabetes. While there may be potential benefit in broader populations, the companies offering CGM-based lifestyle interventions are largely hypothetical and have limited to no evidence at this time upon which to base their offerings.”
Access to CGM growing
Access to CGM is widening. In April, Medicare expanded coverage of CGMs to include people with type 2 diabetes who are taking any type of insulin, as well as people with diabetes not taking insulin with a history of problematic hypoglycemia. The changes will make CGM available to potentially millions more people with diabetes. For people with type 2 diabetes not taking insulin, studies show CGM use is associated with improved HbA1c, increased physical activity, increased fiber and decreased carbohydrate intake, and some weight loss, Philis-Tsimikas said.
“All positive feedback around how to improve lifestyle by the use of intermittent CGM,” Philis-Tsimikas said during the presentation.
For people with early type 2 diabetes or prediabetes, there are few large randomized controlled trials assessing CGM use, though a few smaller qualitative studies suggest improved diabetes self-monitoring, goal setting and self-efficacy to self-monitor with CGM.
Now, several startups are offering CGM for “health and wellness” to people without diabetes, with CGMs available by prescription through a partnering provider, Philis-Tsimikas said. The devices are not covered by insurance and companies typically charge customers monthly fees ranging from $150 to $250 or more, depending on the plan purchased, Philis-Tsimikas said.
“The claim is CGM use can motivate individuals to eat better and maximize exercise, consequently resulting in weight loss,” Philis-Tsimikas said during the presentation. However, the purported benefits are not so straightforward and how such data can best serve healthy adults remains an issue of debate, Philis-Tsimikas said.
“Trying to figure out exactly what is ‘normal’ with CGM [for people without diabetes] is part of what needs to be figured out if we are going to use CGM in some way, shape or form,” Philis-Tsimikas said, noting that people without diabetes will frequently have glucose levels below 70 mg/dL.
More data needed for healthy adults
Philis-Tsimikas said it remains unknown if significant glucose excursions provide valuable feedback for people without diabetes. Additionally, false hypoglycemia or hyperglycemia alerts for those without diabetes could contribute to “alarm fatigue” and potentially promote anxiety.
Instead, potential use of CGM for those without diabetes could include detection of glucose dysregulation at earlier stages of disease with new metrics of glycemic variability, with CGM providing a tool to personalize diet for optimal glucose response, Philis-Tsimikas said. Cost-benefit analyses are also needed.
“All of the underlying theory is there; what we do not have is all of the proof,” Philis-Tsimikas said.
Collapse
Philis-Tsimikas A. Continuous glucose monitoring: The new frontier in lifestyle management? Presented at: Cardiometabolic Health Congress; Oct. 18-21, 2023; Boston.
Read more about
Click Here to Manage Email Alerts