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Continuous glucose monitors (CGMs) are becoming an increasingly popular tool for people with diabetes. Combined, there are roughly 5 million users of the Abbott Libre, Dexcom G5 and G6, and Medtronic Guardian globally.
Like many others living with type 1 diabetes (T1D), I rely on my CGM to make informed decisions. My CGM alarms reduce my anxiety, as they consistently prevent me from sleeping and exercising through dangerous hypoglycemia. Plus, having constant access to my blood glucose levels shows me how different foods affect my blood glucose, how to time a pre-bolus dose of insulin, and much more. After two years of use, I can’t imagine ever going without a CGM again.
My experience aligns well with early research on CGM use and quality of life in people with T1D. However, there is still much research to be done regarding the short- and long-term benefits of this technology for T1D users, as well as its possible other uses—and its limitations. Researchers are still seeking answers to some pretty big, exciting questions, such as:
- What impact does CGM use have on physical health outcomes for people with T1D?
- Does using a CGM significantly impact an individual’s risk of long-term complications?
- What are the long-term effects of CGM use on mental health and quality of life?
- Is CGM technology useful for people living with type 2 diabetes or pre-diabetes? Can it be used as a preventative behavioral tool to promote lifestyle change?
Another exciting prospect is the application of CGMs outside of just diabetes research and treatment. Continuous glucose monitoring has the potential to provide unprecedented insight into nutrition, glucose variability, and the effects of both on long-term health outcomes for people with and without diabetes. It could help researchers explore questions like:
- What is a “normal” range for blood glucose levels, and how much variability is “normal” within that range?
- Do blood glucose fluctuations within this range have measurable effects on energy levels, athletic performance, or even long-term health outcomes?
- Is blood glucose a useful, meaningful health metric for those without diabetes?
There are already some compelling studies on the effect of glycemic variability in people without diabetes. For example, this large 2015 study found that for non-diabetic patients in intensive care, the amount of time spent in a blood glucose range of 70 to 140 mg/dL was strongly associated with survival. A smaller study showed similar findings in patients recovering from cardiac surgery. This research suggests a significant connection between blood glucose levels and health—one that CGM technology could help illuminate.
Although researchers are still far from truly understanding this relationship, this hasn’t stopped some individuals from adopting CGMs as a tool to “hack” their nutrition and fitness goals. Along with their heart rates, sleep, steps, and other similar metrics, these enthusiasts are keeping track of patterns in their blood glucose levels.
Several companies are also marketing their own CGM products and apps to “improve metabolic health” for people without diabetes. These brands say their products can help users improve their energy levels, reach their fitness goals, and more. These promises—and the science they claim to be based on – have yet to be substantiated by peer-reviewed research.
The use of CGMs by people without diabetes has been met with outrage by some members of the diabetes online community (DOC). One major sore spot is regarding access to this tech, which is still cost-prohibitive to many prospective T1D users. Currently, only about 30% of people with T1D in the United States use CGMs. Although cost is not the only factor affecting this figure, it is certainly an important one. In one large 2016 T1D Exchange survey, 61.3% of participants reported cost of supplies as a barrier to using a CGM or insulin pump, while 57% reported cost of device and insurance coverage as barriers.
This topic is also contentious because of the deeply personal nature of living with T1D, a condition associated with depression, disordered eating, and other mental health challenges. When people without T1D use CGMs, they do not experience the mental labor of living with a life-altering condition. In adopting the technology, they do not also inherit fear of hypoglycemia or anxiety regarding long-term complications, for example, nor do they experience the physical discomfort of hyperglycemia.
I also have reservations about the use of CGMs by people without diabetes. Like other people with the condition, I believe that T1D access to CGMs should be a top priority for the technology. I also find it challenging to read content that I feel trivializes or discounts T1D experiences.
More significant, though, is my concern around misinformation. There are already many misconceptions around T1D, including some popular myths about diet. Take, for example, the idea that T1D is caused by a poor diet, or the misconception that people with T1D can’t eat sugar. The association of CGMs with fitness and dieting could give further strength to these myths and others.
Even CGM-related content that is not about T1D can be misleading. When reporting on their use of CGMs, fitness influencers and other individuals without T1D often reference the importance of limiting blood glucose variability for optimal health. Sometimes, they even mention how people with T1D have a broader, slightly higher target range for their glucose levels—but they don’t tend to explain why this range is wider (i.e., to mitigate the acute risks of hypoglycemia), which leaves out an important part of the story.
Ultimately, I think it’s essential that we avoid drawing premature conclusions based on the little research that exists on CGMs to date. Rather than seeing companies capitalize on dubious claims to market this technology to a broader audience, I would prefer to see large-scale research that ultimately provides actionable, evidence-based insights that benefit all people without causing inadvertent harm to some.
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