GRAND ROUNDS

Are Continuous Glucose Monitors Worth It for Those Without Diabetes?

My stance on continuous glucose monitors (CGMs) for healthy, asymptomatic individuals has done a 180 over the past few years.

Don’t believe me? Just take a look at this two-year transformation in my writing:

• A $300M Company that Offers Little Value

• I Hated, but Now Support Continuous Glucose Monitors

Until my most recent piece, CGM Wars: Who Will Lead the Future of Metabolic Health Monitoring?, I had never actually worn a CGM myself. I only managed them for my patients. But since I’ve been writing so much about CGMs, wearables, and healthcare consumerism, my friends at Nutrisense sent me one to try out with their platform.

And I’ll be honest: I loved it.

In this article, I’ll share my personal experience using a CGM, highlight how CGMs fit into the broader healthcare consumerism trend, and explain why I’m now a fan of CGMs in select populations.

My CGM Experience

I received my Dexcom G7, downloaded the Nutrisense app, and set up the Dexcom G7 receiver app. After unpacking the CGM and placing it on the back of my arm, I synced it with the Dexcom app, which then linked with Nutrisense’s platform. Within minutes, I could see my glucose levels in real time.

At the time, I was rotating in the ICU at the VA, where we get three free meals a day (thanks, taxpayers!). The meals? Delicious, but healthy? Eh, not really. Nutrisense would alert me whenever my blood sugar spiked faster than usual. Each time it happened, I’d log what I had eaten (usually something like mac and cheese) or what I was doing (like being in a code with my adrenaline pumping).

After logging my meals for a few weeks, I started noticing patterns—certain foods would send my blood sugar soaring. Residency hasn’t exactly been kind to my health, so when I spiked, I spiked.

Three weeks into my Nutrisense experience, I met with one of their nutritionists, which, honestly, was the best part of the whole process. In medical school, we get zero—literally zero—education on nutrition. The nutritionist walked me through my food log, explained my blood sugar trends, and gave me practical advice on how to adjust my diet to avoid those glucose spikes and lower my fasting sugar. And the advice was truly practical, not like “don’t eat this or that.”

The session was invaluable for two reasons:

1. I learned how my body reacts to specific foods.

2. I got tips I could pass along to my patients to help them manage their blood sugar more effectively throughout the day.

Interestingly, I also noticed how stress affected my blood sugar. After finishing my VA rotation, I returned to my main hospital where the patients were sicker and the services busier. Thanks to the increased stress, my average blood sugar was noticeably higher during those shifts. It felt like I was on a Snickers bar drip all day! Once I realized the connection, I tried to de-stress during the day—whether by stepping outside for a quick break or checking out the pictures my wife sent of our new daughter.

In short, I really enjoyed my Nutrisense experience. The amount of data is amazing—perfect for a data nerd like me—and it’s all presented in a way that’s easy to understand, especially with the help of a nutritionist. The only thing holding me back from continuing? The cost. But to be fair, it’s not much different from what their competitors charge.

Healthcare Consumerism

Healthcare consumerism has come a long way, and CGMs are a perfect example of how devices once meant for a select group—like patients on insulin—are now available to anyone curious about their health.

Dexcom and Abbott, two major players in the CGM world, jumped into the consumer market with more affordable versions of their CGMs, like the Dexcom G7 and Abbott’s FreeStyle Libre. They’re way cheaper than the versions pushed by some digital health companies, but while Dexcom and Abbott give you the data, that’s pretty much it. You can see your glucose numbers, but there’s not much hand-holding beyond that. It’s like getting a car with no GPS—you have the tool, but you’re on your own to figure out how to get where you’re going.

While Nutrisense offers a full-service experience, they’re far from the only player in the consumer CGM market. Companies like Levels and Veri (now acquired by Oura Ring) are also making moves by turning CGM data into a comprehensive health tool for consumers. Levels, for instance, combines CGM data with lifestyle insights, providing users with a personalized metabolic health dashboard. They focus on helping people understand how food, exercise, and even stress affect their glucose levels in real-time.

Dashevsky’s Dissection

I was initially skeptical about CGMs, but now I’m on board. That said, they’re not for everyone. I see three groups of people (besides those on insulin) who could really benefit from using CGMs:

• Those with type 2 diabetes or pre-diabetes: for the former, patients can see how they respond to certain foods and anti-diabetic medications, getting that instant feedback. This can reinforce good behaviors and extinct bad ones, leading to better health. For the latter group, knowing where you’re trending (moving towards or away from diabetes) may encourage you to take more preventive measures.

• Those with a strong family history of type 2 diabetes: similar to my explanation above, those with a strong family history of diabetes may benefit from knowing where they stand: moving towards or away from diabetes. This is especially true if you’re in your 20s or 30s when you’re locking in habits around food and exercise that will shape your health in the decades to come. Being proactive now can set you up for success later.

• Those who love data: CGMs are just another wearable providing constant streams of data. I love data, and I know some of you do, too. It’s a great way to analyze your habits and honestly take control. I have CGM on my left arm, a WHOOP on my right arm, and a Garmin on my left wrist. The first thing I do when I wake up is check my sleep performance and fasting sugars. It helps me plan my day and week when it comes to exercising, eating, and resting.

Now, if you don’t fall into one of these categories, a CGM might not offer much benefit—and it could even cause harm. A recent paper in Diabetic Medicine highlighted some concerns about using CGMs in people without diabetes. The paper pointed out that there’s still a lack of consistent, high-quality evidence showing that CGMs lead to better health outcomes in people without diabetes. In fact, constantly monitoring glucose levels can lead to unnecessary anxiety or even disordered eating patterns—something the paper referred to as “glucorexia.” The fear is that people might become overly focused on slight, clinically insignificant glucose changes, leading to unhealthy habits.

As I said in my first article on CGMs:

So, there you have it—my current thoughts on CGMs. And I promise, I’ll stop writing about this… unless, of course, another CGM company gets scooped up in a big acquisition. Then, well, you know where to find me.

In summary, while my perspective on CGMs has evolved from skepticism to support, it’s clear that CGMs aren’t for everyone. They offer significant benefits for specific groups, like those with type 2 diabetes, pre-diabetes, a family history of diabetes, and data enthusiasts. However, for those outside these categories, the utility of CGMs may be limited, and as recent research suggests, constant glucose monitoring could lead to unnecessary anxiety or unhealthy behaviors in otherwise healthy individuals.

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OUTSIDE THE HUDDLE

Some of my favorite content from this past week.

• Healthcare startup Suki raised $70 million in a Series D round to further develop its AI voice assistant for reducing administrative workloads in healthcare. The company, integrated with over 300 health systems and major EHRs, will use the funds to enhance its products, competing with Microsoft’s Nuance and other startups like Abridge. I’m a big fan of Suki.

• CVS Health is considering breaking up its vertically integrated business, including its Aetna acquisition, in the setting of financial struggles and regulatory pressures, particularly surrounding its PBM Caremark. This potential breakup could signal a broader industry shift away from healthcare mega-mergers, as other companies like Walgreens and Rite Aid face similar challenges. Tangentially, I wrote about the Rise and Fall of Retail Health.

• The Biden administration’s argument that EMTALA mandates emergency abortions in life-threatening situations has been blocked in Texas, as courts sided with the state’s challenge, and the Supreme Court declined to intervene. This decision, along with rulings in similar cases, has left doctors in states with restrictive abortion laws confused about whether to follow federal or state guidelines for emergency care. Check out my latest on women’s health coverage.

• Victor Ambros and Gary Ruvkun were awarded the 2024 Nobel Prize in Physiology or Medicine for discovering microRNA, a crucial molecule that regulates gene activity by inhibiting protein production. This discovery has profound implications for understanding development, evolution, and diseases like cancer and congenital disorders.

• Eli Lilly’s Zepbound and Novo’s Wegovy are undergoing a high-stakes head-to-head trial (SURMOUNT-5), with results expected by year-end, while Novo’s next-generation drug, cagrisema, is also in late-stage testing. Other contenders like Amgen’s maritide and Roche’s GLP-1 pill are advancing through trials, aiming to offer alternatives to injectable obesity treatments. Additionally, companies like Veru and Skye Bioscience are exploring approaches to preserve muscle mass and target new mechanisms like CB1 inhibition in the fight against obesity. Check out Healthcare Dive’s article here.

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