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. 2023 Nov;17(6):1686-1697.
doi: 10.1177/19322968221110830. Epub 2022 Jul 20.

Use of Continuous Glucose Monitors by People Without Diabetes: An Idea Whose Time Has Come?

David C Klonoff  1 , Kevin T Nguyen  2 , Nicole Y Xu  2 , Alberto Gutierrez  3 , Juan C Espinoza  4   5 , Alaina P Vidmar  4   5
Affiliations

Use of Continuous Glucose Monitors by People Without Diabetes: An Idea Whose Time Has Come?

David C Klonoff et al. J Diabetes Sci Technol. 2023 Nov.

Abstract

Background: Continuous glucose monitor (CGM) systems were originally intended only for people with diabetes. Recently, there has been interest in monitoring glucose concentrations in a variety of other situations. As data accumulate to support the use of CGM systems in additional states unrelated to diabetes, the use of CGM systems is likely to increase accordingly.

Methods: PubMed and Google Scholar were searched for articles about the use of CGM in individuals without diabetes. Relevant articles that included sufficient details were queried to identify what cohorts of individuals were adopting CGM use and to define trends of use.

Results: Four clinical user cases were identified: (1) metabolic diseases related to diabetes with a primary dysregulation of the insulin-glucose axis, (2) metabolic diseases without a primary pathophysiologic derangement of the insulin-glucose axis, (3) health and wellness, and (4) elite athletics. Seven trends in the use of CGM systems in people without diabetes were idenfitied which pertained to both FDA-cleared medical grade products as well as anticipated future products, which may be regulated differently based on intended populations and indications for use.

Conclusions: Wearing a CGM has been used not only for diabetes, but with a goal of improving glucose patterns to avoid diabetes, improving mental or physical performance, and promoting motivate healthy behavioral changes. We expect that clinicians will become increasingly aware of (1) glycemic patterns from CGM tracings that predict an increased risk of diabetes, (2) specific metabolic glucotypes from CGM tracings that predict an increased risk of diabetes, and (3) new genetic and genomic biomarkers in the future.

Keywords: CGM; athletes; continuous glucose monitor; healthy; obesity; prediabetes.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: DCK is a consultant for Eoflow, Eli Lilly, Lifecare, Integrity, Medtronic, Roche Diagnostics, Rockley Photonics, and Thirdwayv. KTN and NYX are consultants for Abbott Diabetes Care. AG is a contract consultant for the ProPharma Group and helps medical device companies with regulatory issues. JCE is a paid consultant for AI Health. JCE’s time is supported in part by the Food and Drug Administration under award number P50FD006425 for The West Coast Consortium for Technology & Innovation in Pediatrics (PI: Espinoza). APV receives CGM product in kind from Dexcom for research conduct. The content is solely the responsibility of the authors and does not necessarily represent the official views of the FDA.

Figures

Figure 1.
Figure 1.
Results of studies reported since 2007 using CGMs to determine times spent in various ranges of glucose concentrations in populations of people with normal baseline fasting and glucose tolerance tests. Under “reported time in ranges,” the gray bars represent the range of glucoses reported in each study. If the original study reported exact minimum or maximum values, the gray bar has hard edges; otherwise it has faded edges if only “less than” or “greater than” were used in the data reporting. The dotted lines at 70mg/dL and 140 mg/dL are not shown for studies that used different cut-off values. Established target times in ranges for patients with type 1 diabetes per the International Consensus on Time in Range. Abbreviations: CGM, continuous glucose monitor; T1D, type 1 diabetes; TAR, time above range; TBR, time below range; TIR, time in range.
Figure 2.
Figure 2.
Clinical use case domains for continuous glucose monitors. Abbreviations: CGM, continuous glucose monitor; DM, diabetes mellitus; T2D, type 2 diabetes.
See this image and copyright information in PMC

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