Consumer continuous glucose monitoring uncovers hidden metabolic risk in free-living adults without diabetes

Average glucose from consumer CGM is the most reliable metric across weeks in 62,122 free-living adults without diabetes, with an intraclass correlation of 0.747.

• Why it matters: CGM use in non-diabetes adults is debated because common CGM metrics were built for diabetes, and screening often depends on HbA1c.
• What they did: In 7,930 participants without diabetes with lab tests, average glucose tracked insulin resistance and cardiometabolic markers more closely than HbA1c, explaining nearly three times more variance in fasting insulin (R2 0.131 vs 0.048).
• The result: With normal HbA1c, occult hyperinsulinemia (fasting insulin ≥10 microIU/mL) was linked to higher average glucose (≥110 mg/dL), occurring in 27.5% vs 12.6%, and spike width tracked insulin resistance, triglycerides, and C-reactive protein.

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