CGM flags cardiometabolic risk in people without diabetes

Clinical takeaway: When CGM data are available for adults without diabetes, consider greater time above 140 mg/dL a potential marker of cardiometabolic risk, but continue to base screening and treatment decisions on validated tests and risk tools.

Fasting plasma glucose and HbA1c remain the standard tools for assessing glycemia, but they provide only a snapshot of glucose status. As CGM use expands beyond diabetes care, researchers are exploring whether continuous glucose patterns can reveal earlier signs of metabolic dysfunction and cardiovascular risk.

In this cross-sectional analysis of 1,356 participants from the Framingham Heart Study who had neither diabetes nor cardiovascular disease, investigators evaluated up to 10 days of blinded CGM data alongside traditional cardiometabolic risk measures. Participants had a mean age of 59 years, and 56.6% met conventional criteria for normoglycemia.

Higher CGM-derived glycemic burden, reflected by mean glucose levels and time spent above 140 mg/dL, was consistently associated with less favorable cardiometabolic profiles. Every 15% increase in time spent above 140 mg/dL was associated with roughly 2% to 4% higher estimated 10-year cardiovascular risk and 21% to 26% higher odds of hypertension or dyslipidemia, even after adjustment for fasting plasma glucose. By contrast, most measures of glucose variability were not independently associated with cardiovascular risk.

Notably, CGM identified substantial heterogeneity within traditional glycemic categories. Many participants classified as normoglycemic by fasting glucose and HbA1c demonstrated CGM patterns consistent with varying degrees of dysglycemia, while CGM-defined high-burden glycemic profiles were associated with 6% to 7% higher predicted cardiovascular risk and worse blood pressure and lipid profiles.

“Understanding temporal glucose patterns may be pivotal in uncovering early or intermittent dysglycemia and its downstream cardiometabolic risks,” said corresponding author Nicole Spartano, PhD. “Continuous glucose monitoring may aid this in characterizing the heterogeneity underlying dysglycemia by enabling phenotyping of individuals across the blood sugar continuum.”

Source: Bakhshi B, et al. (2026 Sep 17) Diabetes Care. Beyond Traditional Glycemic Measures: CGM Glycemic Profiles Reveal Associations With Cardiometabolic Risk in Individuals Without Diabetes