CGM Data Links Glycemic Burden to Cardiovascular Risk Without Diabetes

A study of 1356 adults without diabetes or cardiovascular disease (CVD) found that certain continuous glucose monitor (CGM) measures were linked to higher estimated 10-year CVD risk and worse cardiometabolic risk factors, even after accounting for fasting plasma glucose (FPG) and body mass index (BMI). The findings, published in Diabetes Care, suggest CGM data can reveal metabolic heterogeneity that FPG and HbA_1C alone do not capture in people without type 2 diabetes (T2D).¹

Investigators from the Framingham Heart Study (FHS) said the results point to a potential role for CGM phenotyping in cardiometabolic risk stratification, though independent researchers have cautioned that clinical benefit for individuals without diabetes remains unproven.²

Glycemic Burden, Not Variability, Drove the Association

Participants were drawn from the FHS Third Generation, New Offspring Spouse, and Omni 2 cohorts and wore a blinded Dexcom G6 Pro CGM for up to 10 days, along with completing a mixed-meal tolerance test (MMTT) before and 2 hours after a standardized 600-kcal liquid meal. The final analytic sample excluded participants with prevalent T2D, cardiovascular disease, or missing covariates. The mean age was 59.3 years, 55.8% were women, and 92.6% were nonHispanic white.¹

Investigators used the American Heart Association's Predicting Risk of Cardiovascular Disease Events (PREVENT) equations to estimate 10-year CVD risk and applied multivariable linear and logistic regression models adjusted for FPG and BMI.¹

Measures of glycemic burden—mean glucose and percentage of time spent above 140 mg/dL and composite scores, such as the Glycemic Risk Assessment Diabetes Equation—were consistently associated with higher 10-year CVD risk estimates, even after adjustment for FPG. A 1-SD increase in percentage of time above 140 mg/dL (15.4%) was associated with 21% to 26% higher odds of hypertension and dyslipidemia independent of FPG, and a 1-SD increase in mean glucose was associated with 53% higher odds of having a PREVENT risk estimate of 7.5% or greater (95% CI, 1.11-2.11) compared with a risk estimate below 5%.¹

Measures of glycemic variability, including coefficient of variation and mean amplitude of glycemic excursions, showed no significant association with CVD risk estimates. The 2-hour post-MMTT glucose reading was tied to 3% higher 10-year CVD risk estimates and 25% to 30% higher odds of hypertension or dyslipidemia.¹

CGM Profiles Revealed Risk Hidden by Standard Testing

Investigators also grouped participants into glycemic profiles using 2 approaches, including a phenotype-driven binary classification based on glycemic burden and variability and a data-driven unsupervised clustering method. Both approaches showed substantial overlap with, but also divergence from, traditionally defined glycemic status.¹

Between 48.1% and 84.2% of participants with traditionally defined prediabetes fell into CGM profiles representing higher dysglycemia, and those higher-dysglycemia profiles were associated with 6% to 7% higher 10-year predicted CVD risk estimates after adjustment for confounders. Cardiometabolic profiles, including triglycerides, high-density lipoprotein cholesterol, and the triglyceride-glucose index, worsened progressively across the more severe glycemic profiles.¹

Independent Researchers Urge Caution on Clinical Use

Despite the associations, researchers outside the FHS group say it remains unclear how CGM data should guide care for people without diabetes. "In people without diabetes, we don't really know how to act on differing glucose patterns," Michael Fang, PhD, MHS, assistant professor in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health, said in a post for Johns Hopkins.² "All the clinical information about how to interpret and act on the information from CGMs is for people with diabetes," he said.²

Elizabeth Selvin, PhD, MPH, a professor in the same department, said lab-based screening remains the standard for identifying metabolic risk. "If you have prediabetes, the only way to find out is to get screened" using lab tests, Selvin said.²

"Regular screening using lab tests such as glucose and HbA_1C is still the best way to understand risk," she said, adding that "we don't actually know that monitoring or manipulating CGM glucose levels in people without diabetes can improve health."²

Fang noted that no major clinical trials have tested whether CGM use produces measurable health benefits in people without diabetes and that the FDA's decision to allow OTC CGM sales did not hinge on evidence of improved health outcomes.²

A JAMA Internal Medicine patient page similarly states there is no good evidence that CGM use improves health or prevents disease in people without diabetes, and no evidence that it lowers blood glucose levels in this population, in contrast with a modest 0.3% HbA_1C reduction seen in people with type 2 diabetes who use CGM for at least 8 to 10 weeks.³

What It Means for Pharmacists

With OTC CGMs now marketed directly to consumers as wellness tools, pharmacists are likely to field questions from patients without diabetes about whether the devices are worth using.⁴

The FHS findings suggest CGM-derived glycemic burden may correlate with cardiometabolic risk factors pharmacists already screen for, such as hypertension and dyslipidemia, but the study's authors and outside researchers agree that CGM data should supplement, not replace, standard lab-based glucose and HbA1c screening.^1-3

Pharmacists counseling patients on OTC CGM use may want to reinforce that glucose spikes alone should not drive dietary decisions that trade one health risk for another and that fasting glucose and HbA_1C remain the established tools for diagnosing prediabetes and diabetes.²

REFERENCES

1. Bakhshi B, Lin H, Sultana N, et al. Beyond Traditional Glycemic Measures: CGM Glycemic Profiles Reveal Associations With Cardiometabolic Risk in Individuals Without Diabetes. Diabetes Care. Published online September 17, 2026. doi:10.2337/dc26-1197

2. Winny A. Are glucose monitors useful for people who don't have diabetes? Johns Hopkins Bloomberg School of Public Health. January 28, 2026. Accessed September 22, 2026. https://publichealth.jhu.edu/2026/is-glucose-monitoring-useful-for-non-diabetics

3. Johansson M, Dower JA, Lipska KJ. Continuous glucose monitoring for persons with and without diabetes. JAMA Intern Med. Published online August 3, 2026. doi:10.1001/jamainternmed.2026.2769

4.Klonoff DC, Nguyen KT, Xu NY, Gutierrez A, Espinoza JC, Vidmar AP. Use of Continuous Glucose Monitors by People Without Diabetes: An Idea Whose Time Has Come?. J Diabetes Sci Technol. 2023;17(6):1686-1697. doi:10.1177/19322968221110830