A common question I get asked is ‘why should I bother monitoring my glucose?’. It’s a valid question considering using a CGM is only currently recommended and subsidised for Type 1 Diabetics. Despite this, there are numerous reasons why using a glucose monitor for non-diabetics can be beneficial to health, and there is a growing amount of researchers combing through the data to back this up.
In this post, I discuss some of the benefits and drawbacks of using a CGM so that readers can make an informed decision about whether or not the technology is right for them.
A quick refresher on what a CGM actually is
A continuous glucose monitor (CGM) is a tiny, minimally-invasive device that is attached to the arm and delivers ongoing and instantaneous glucose readings. With the help of continuous glucose monitoring, one can get a clear understanding of how their blood sugar changes during the day. This data can be used to analyse distinct patterns and trends that result from food intake, stress, exercise, sleeping habits, and other daily activities.
Benefits of using a Continuous Glucose Monitor
Reduce chronic disease risk
It is estimated that over 2 million Australians are pre-diabetic and a further 550,000 people have undiagnosed type 2 diabetes. The stats are even more staggering in the US, with approximately 96 million adults (1 in 3) having prediabetes. Alarmingly, 80% of those with pre-diabetes don't even know they have it.
The current healthcare system is mainly set up to treat people once they have a chronic condition, meaning that clinical care is often better equipped to put out fires rather than prevent them. Most people don’t get regular blood tests done until an issue arises and even if you are getting regular tests done it’s difficult to understand if there’s been any decline in your metabolic health.
Metabolic health should be viewed on a spectrum, not just as healthy or unhealthy. There’s so much space between being in peak health and developing type 2 diabetes. Wearing a CGM can help you gain more insight as to where you sit on this spectrum and can therefore be seen as an important step to preventing chronic disease down the track.
Understand how your lifestyle choices impact blood sugar levels
Nutrition, exercise, sleep, and stress all have an effect on blood sugar levels. What's fascinating is that each individual's glucose response is unique. Using food as an example, this means that how one person responds to a particular meal might be completely different to someone else trying the exact same foods.
A seminal study published in the journal Cell tracked nearly 47 000 meals from an 800 person cohort. Using CGM's to measure glucose, the researchers discovered high variability in the response to identical meals, suggesting that universal dietary recommendations may have limited utility. What this means is that monitoring glucose gives people the opportunity to move away from generalised advice and into more personalised health.
A powerful tool to empower behaviour change
There is a wide range of evidence on how wearing an activity tracker encourages and increases peoples physical activity. A CGM takes this to the next level, by giving you instant feedback on how lifestyle decisions are affecting a major part of your metabolic health. Sometimes, you have to ‘see it to believe it’.
Seeing healthy choices produce positive results in real time can provide motivation and self-confidence to keep going. Further, identifying a problem area with objective data can help people move through the stages of change. For example, someone might be oblivious to how stress impacts their blood sugar levels. Matching a stressful event to a sharp rise in blood sugar might be the tipping point for someone who’s been contemplating meditation or mindfulness.
Measure glycaemic variability
Glycaemic variability refers to how much your blood glucose moves up and down throughout the day, and poor glucose control can lead to poor health outcomes. When you eat a meal it is normal for your blood sugar to rise. The key is that it doesn't rise too much and comes back down to pre-meal levels in an appropriate amount of time. It has been shown in the research that excessive post-meal glucose spikes are an independent risk factor for many chronic conditions. A CGM will help to identify glucose variability, post-meal spikes, and average glucose over a 24 hour period.
Avoid energy slumps
When too many refined carbohydrates are consumed the result will be an excess of free floating sugar in the bloodstream. When this occurs, the pancreas will secrete the hormone insulin to push the free sugars into cells or to be used as storage. This process is not always efficient and sometimes too much insulin is secreted, clearing too much sugar and thus leading to low blood sugar aka an energy slump. Using a CGM provides a closed feedback loop which helps you identify what foods may be causing unnecessary dips in glucose levels.
Reasons against using a Continuous Glucose Monitor
The use of CGMs as a wellness product is a relatively new concept and therefore there is not a lot of scientific evidence on the benefits for non-diabetics. With a wide range of global start-ups in the space having huge waiting lists, the evidence base is growing, but to this point, the body of research is not conclusive on the advantages for healthy individuals.
May promote obsessive/restrictive eating behaviours
A product that gives such an in depth view in to how lifestyle choice affects metabolic health, in the wrong hands, could lead to obsessive and restrictive eating behaviours. Without expert guidance, a CGM might encourage uninformed individuals to choose less nutritious foods just because they didn't spike their blood sugar as much. Unfortunately, examples of this are already popping up on social media.
Potential to cause supply chain issues for Diabetics
At this stage, these devices are first and foremost for type 1 Diabetics to support the use of insulin. If there is rapid adoption of cgm use from non-diabetics this might cause disruption within the supply chain. This could lead to those that need it most, missing out or having to wait longer periods of time before having access to the monitors.
As of late 2022, the cost of using a continuous glucose monitor for one year in Australia is approximately $2500. Although monitoring your glucose for a whole year is not necessary to get valuable insights, it is still worth weighing up against other health promoting products depending on what your health goals are.
Overall, I am definitely in favour of using CGMs for non-diabetics and believe wearables that measure analytes are part of the future of proactive health. With that said, these types of devices are not for everyone and should be used in conjunction with a health professional who understands how blood glucose works - GP’s, Dietitians, and Diabetes educators being some examples.
Thanks for reading! This is the first in a series I'm writing on the use of CGM’s for non-diabetics. Next up, CGM experiment: Personal insights and learnings from using a continuous glucose monitor for 28 days.
Zeevi, D. et al. (2015) Personalized nutrition by prediction of glycemic responses, Cell. Elsevier. Available at: https://www.cell.com/cell/fulltext/S0092-8674%2815%2901481-6 (Accessed: December 8, 2022).
Ferguson, T. et al. (2022) Effectiveness of wearable activity trackers to increase physical activity and improve health: A systematic review of systematic reviews and meta-analyses, The Lancet Digital Health. Elsevier. Available at:
https://www.thelancet.com/journals/landig/article/PIIS2589-75002200111-X/fulltext (Accessed: December 8, 2022).
National Diabetes Statistics Report (2022) Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/diabetes/data/statistics-report/index.html (Accessed: December 8, 2022).
Pre-diabetes | diabetes Australia (no date). Available at: https://www.diabetesaustralia.com.au/about-diabetes/pre-diabetes/ (Accessed: December 8, 2022).