Wearable health technology is on the rise, with continuous glucose monitors (CGMs) increasingly marketed beyond their original purpose of diabetes management. Once limited to individuals with type 1 and insulin-dependent type 2 diabetes, these devices are now being widely promoted to people not living with diabetes (PNLD) as a tool for optimising diet and metabolic health.
Certainly it can be fun to see the data to come in after eating a variety of foods and make judgements on what or how to eat. However, a new review published in Diabetic Medicine raises critical concerns about the scientific basis for this growing trend.
As ever, please talk to your doctor or medical practitioner most familiar with your medical history before implementing any changes in diet, exercise or lifestyle, especially if you are under treatment. Links to all studies at bottom of page.
The Promises and the Reality
Proponents of CGMs in PNLD suggest that real-time glucose tracking offers insights into how different foods and activities impact blood sugar levels, allowing users to make informed dietary choices. Some companies even claim that CGMs help prevent metabolic conditions such as type 2 diabetes through behaviour change and personalised nutrition.
However, the review by researchers at University College London (UCL) and Birmingham Children's Hospital finds that these claims are not backed by strong scientific evidence.
After analysing 27 relevant studies, the authors conclude that there is little data supporting the utility of CGMs in detecting glucose abnormalities, driving meaningful behavioural change or improving metabolic health in PNLD. In fact, clinical guidelines currently do not recommend CGMs for anyone outside of diabetes management, highlighting a clear disconnect between regulated medical use and commercial marketing strategies.
Accuracy Concerns
One major issue identified in the review is the accuracy of CGMs in people without diabetes.
CGMs measure glucose levels in interstitial fluid rather than directly in the blood, leading to delayed or imprecise readings. While the most advanced CGMs meet regulatory accuracy thresholds for diabetes management, data on their reliability in PNLD is scarce. Inaccurate readings could result in unnecessary dietary restrictions or anxiety over natural glucose fluctuations, which vary between individuals and throughout the day.
Even the most accurate CGMs have a 20% margin of error. A reading of 5.5 mmol/L could actually range from 4.4 to 6.6 mmol/L - a significant difference for a non-diabetic person. Moreover, CGM data lacks standardised benchmarks for PNLD, unlike clinical markers such as fasting glucose or HbA1c. Without clear reference points, misinterpretation of readings may contribute to unnecessary health concerns.
Potential Risks and Psychological Impacts
Beyond accuracy concerns, the review highlights psychological risks. Continuous glucose monitoring may lead to obsessive food tracking and restrictive eating patterns, increasing the risk of orthorexia - where food choices are dictated by glucose responses rather than overall nutrition. False alarms from CGMs could also trigger stress and confusion.
These risks are particularly concerning given how CGMs are marketed. Unlike individuals with diabetes, who use them under medical supervision, PNLD are often left to interpret their data with little guidance, increasing the potential for misinformed lifestyle decisions.
Final Thoughts
The expansion of CGMs beyond diabetes care is an interesting development, but the current evidence does not support their widespread use in PNLD. While the technology is valuable for managing blood sugar in diabetes, claims about its benefits for metabolic health improvement and disease prevention in healthy individuals remain largely speculative. Accuracy concerns, the risk of misinterpretation and potential psychological effects further complicate the case for CGMs in this population.
We have used CGMs ourselves, to understand the process and analyse the data. Admittedly it was fascinating to see the data come in, represented in graph form. To see the body's natural response to consuming food as meals and - when put to the test - responses to single items, say: fruit or nuts, or a biscuit etc. Fortunately we are able to interpret the results, to understand our glucose spikes and put them into correct context. Note, glucose spikes are a normal, response to eating carbs, read more here.
Ultimately, more high-quality, long-term research is needed before CGMs can be confidently recommended for PNLD. Until then, individuals considering CGM use for general health should approach with caution and be wary of commercial claims that lack scientific backing. By all means, track and experiment if you want to - just be aware of the limitations.
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Alastair
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Studies and Resources
Oganesova Z, Pemberton J, Brown A. Innovative solution or cause for concern? The use of continuous glucose monitors in people not living with diabetes: A narrative review. Diabet Med. 2024 Sep;41(9):e15369. doi: 10.1111/dme.15369. Epub 2024 Jun 26. PMID: 38925143.
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