Emerging evidence and clinical experience suggest continuous glucose monitors (CGMs) may offer meaningful insights for patients with early type 2 diabetes or prediabetes, supporting behavior change and more personalized risk assessment.
“I am a strong advocate for the strategic use of CGMs in prediabetes,” said Mihail Zilbermint, MD, an associate professor of clinical medicine in the Division of Endocrinology, Diabetes, and Metabolism at Johns Hopkins University School of Medicine in Baltimore. “They have a great potential to transform how we engage patients who are at risk; they provide real-time feedback, making invisible things visible.”
Kevin Miller, DO, board-certified family physician and member of the American Diabetes Association’s Primary Care Committee, said CGMs are here to stay. “I don’t think there is any going back; we’re going to be using them.”
Yet, there are barriers to accessing CGMs. There is also a lack of long-term data and consensus among experts on their broader use.
The Case for CGMs in Early Diabetes
Available by prescription and over the counter, CGMs measure interstitial glucose levels via a small sensor placed under the skin. They enable trend analysis, time-in-range tracking, and identification of fluctuations in blood glucose levels.
These features help patients link diet, sleep, stress levels, and activity with glycemic variability, ultimately unveiling patterns — perhaps their most critical role, said Anne Peters, MD, director of the University of Southern California’s Clinical Diabetes Programs.
“I think CGMs are great because they make people aware of the composition of their food,” she said. If a patient starts to notice that eating cereal for breakfast increases their blood sugar level to 200 mg/dL, they may stop eating cereal for breakfast — and be healthier for it.
Data suggest as much. “Some emerging studies suggest that intermediate CGM use can improve food choices, physical activity, and overall glycemic variability, even in people without diabetes,” Zilbermint said.
One study published in Diabetes, Obesity and Metabolism found that CGMs paired with education led to weight loss and improved low-density lipoprotein cholesterol levels in people with type 2 diabetes and prediabetes. Other research has found that CGM use with personalized nutrition therapy doubled weight loss and fat reduction in people with prediabetes.
The Limitations of CGMs
Early studies and expert opinion suggest that CGMs may support behavior change and improve metabolic markers in people with prediabetes or early type 2 diabetes, yet data from long-term randomized controlled trials to support routine CGM use in these populations are lacking.
The American Diabetes Association and the Endocrine Society acknowledge the potential of CGMs in broader populations. Still, current guidelines do not recommend their routine use in those with prediabetes or type 2 diabetes who are not on insulin or other glucose-lowering agents.
Miller, currently involved in research on using CGMs in those