- Department of Endocrinology and Metabolism, Beijing Tsinghua Changgung Hospital, Tsinghua University Clinical Medical School, Tsinghua University, Beijing, China
Editorial on the Research Topic
Continuous glucose monitoring: beyond diabetes management
Since the establishment of the causal relationship between blood glucose levels and diabetes complications, glycemic control has become a cornerstone of diabetes metabolic management (1). In recent years, continuous glucose monitoring (CGM) systems have emerged as transformative tools for diabetes care (2). By measuring glucose levels in interstitial fluid, CGMs provide near-continuous real-time glucose readings and comprehensive ambulatory glucose profiles (AGP) (3). These capabilities are critical for optimizing insulin dosing, dietary planning, and physical activity management (4–6). The real-time visualization of glycemic variability has not only revolutionized diabetes treatment but also significantly enhanced patients’ quality of life (7). Moreover, CGM-derived metrics such as Time in Range (TIR), Time Below Range (TBR), and Time Above Range (TAR) have introduced new paradigms in glycemic assessment (3). Notably, the application of CGM is expanding beyond traditional diabetes management, opening new frontiers in personalized health optimization. This article reviews current evidence including articles in this Research Topic, to discuss the potential applications, limitations, and prospects of CGM technology.
Beyond diabetes management: expanding applications of CGM
We know that glucose is a major substrate of energy metabolism and a core player in overall metabolic health, energy regulation, and cellular function. Fluctuations, even within physiologically “normal” ranges - can profoundly influence wellbeing and performance (8). This understanding has driven growing interest in CGM applications among non-diabetic populations:
1. Optimize metabolic health & prevent diabetes:
CGM provides immediate, personalized feedback on how specific foods and dietary components (carbohydrate type/fiber/fat/protein ratio, serving size, order) affect blood glucose (9). One person’s “healthy” meal can cause another person’s blood sugar to spike dramatically (10). CGM provides support for truly personalized dietary choices to minimize harmful blood sugar spikes and promote metabolic stability.
2. Early identification and prevention of dysglycemia: CGM can reveal abnormal blood glucose fluctuations long before standard fasting blood glucose or HbA1c tests show abnormalities (11). Users seeing frequent or prolonged postprandial spikes can be a powerful motivator for lifestyle interventions to prevent the progression to type 2 diabetes (12).
3. Athlete nutrition management and training intensity monitoring (13).
Athletes rely heavily on glycogen stores. CGM helps them understand how different fuel strategies affect glucose availability and stability during training and competition. At the same time, glycemic patterns after exercise can provide clues about recovery status and the effectiveness of energy replenishment. A stable blood glucose overnight after strenuous activity indicates adequate nutrition, while an unstable blood sugar may indicate inadequate intake or constant stress. CGM can sometimes show how different training loads or types affect glucose regulation, potentially marking over-training states.
4. Weight Management and Body Composition Goals:
The “calorie intake, calorie burn” model is increasingly seen as oversimplifying. A spike in blood sugar triggers the release of insulin, a hormone that promotes fat storage and can inhibit fat burning (14). To identify foods that cause significant spikes and to choose dietary variety(i.e. low carbohydrate high protein) promoting more stable glucose and insulin levels, potentially create a more favorable hormonal environment for fat loss and muscle gain (15). Furthermore, large blood glucose spikes are often accompanied by rapid drops, which can trigger hunger, fatigue, and cravings – especially for more carbohydrates or sugar (16). Minimizing these spikes through dietary modification probably supports adherence to healthy eating patterns.
5. Understand energy, mood, and nerve function:
Many people with diabetes experience depression. CGM can directly link these subjective feelings to blood sugar levels (17). Minimizing extreme blood sugar fluctuations by taking a CGM may help some people improve the nerve response to hypoglycemia (18).
6. Women’s Health and Hormonal Fluctuations:
Hormones such as estrogen and progesterone significantly affect insulin sensitivity. In most of the study population, glucose levels rose linearly throughout the menstrual cycle, reaching a maximum in the late luteal phase. A sharp decrease was seen in women at the beginning of menstrual bleeding (19). Polycystic ovary syndrome (PCOS) is often associated with insulin resistance. CGM can be a valuable tool for managing blood glucose levels in women with PCOS.
7. Longevity and diets intervention:
Some researchers hypothesize that minimizing high blood sugar spikes and excessive variability (even within normal limits) may reduce oxidative stress and inflammation, potentially slowing the aging process (20). CGM provides data to proactively manage this variability. Biohackers used CGM to test the effects of various interventions—specific diets (ketosis, intermittent fasting), supplements, sleep patterns, stress reduction techniques—on their blood glucose profile, seeking optimal metabolic function (21).
8. Enhancing Quality of Life in Special Diabetic Populations.
Type 1 diabetes management faces unique challenges during Ramadan, where patients experience dawn phenomenon before Suhoor meals, post-Iftar hyperglycemia, and nocturnal hypoglycemia risks. (Alguwaihes et al.) Similarly, pregnant women with diabetes endure significant psychological burdens from stringent glycemic targets. Liu et al. found CGM improved self-rating anxiety, pregnancy-related anxiety, and diabetes specific quality of life. While advanced technologies like sensor-augmented pumps with automated insulin suspension theoretically alleviate hypoglycemia fear syndrome (HFS), current evidence indicates limited improvement regardless of SmartGuard™ or CGM implementation—potentially due to insufficient usage duration. (Schierloh et al.) Notably, CGM offers unique advantages for evaluating novel hypoglycemic agents through comprehensive pharmacodynamic profiling of glucose excursions, surpassing traditional spot-check measurements (Wei et al.).
Technical limitations and future trajectory
Despite promising applications, CGM technology faces inherent physiological constraints. Accuracy needs next generation technology or systemic calibration. (Wu et al.) The 5–15 minute physiological lag between interstitial fluid and blood glucose measurements becomes particularly problematic during rapid glycemic fluctuation (22). Accuracy challenges persist during intense physical activity and other metabolic stressors (Maytham et al.). Implementation barriers include clinical data overload (“glucose fatigue”), reimbursement limitations for non-diabetic applications, and privacy concerns regarding cloud-stored health data (23). Future developments will likely focus on multimodal biometric integration, machine learning-enhanced predictive alert systems, and closed-loop systems for health optimization. These innovations may ultimately transform CGM from a monitoring tool into integrated health management platforms (24).
Author contributions
JX: Writing – original draft, Writing – review & editing. ZL: Writing – review & editing.
Conflict of interest
The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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References
1. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. (1998) 352:837–53. doi: 10.1016/S0140-6736(98)07019-6
2. Uhl S, Choure A, Rouse B, Loblack A, and Reaven P. Effectiveness of continuous glucose monitoring on metrics of glycemic control in type 2 diabetes mellitus: A systematic review and meta-analysis of randomized controlled trials. J Clin Endocrinol Metab. (2024) 109:1119–31. doi: 10.1210/clinem/dgad652
3. Nguyen M, Han J, Spanakis EK, Kovatchev BP, and Klonoff DC. A review of continuous glucose monitoring-based composite metrics for glycemic control. Diabetes Technol Ther. (2020) 22:613–22. doi: 10.1089/dia.2019.0434
4. Nwokolo M and Hovorka R. The artificial pancreas and type 1 diabetes. J Clin Endocrinol Metab. (2023) 108:1614–23. doi: 10.1210/clinem/dgad068
5. Song J, Oh TJ, and Song Y. Individual postprandial glycemic responses to meal types by different carbohydrate levels and their associations with glycemic variability using continuous glucose monitoring. Nutrients. (2023) 15:3571. doi: 10.3390/nu15163571
6. Moser O, Zaharieva DP, Adolfsson P, Battelino T, Bracken RM, Buckingham BA, et al. The use of automated insulin delivery around physical activity and exercise in type 1 diabetes: a position statement of the European Association for the Study of Diabetes (EASD) and the International Society for Pediatric and Adolescent Diabetes (ISPAD). Diabetologia. (2025) 68:255–80. doi: 10.1007/s00125-024-06308-z
7. Polonsky WH and Fortmann AL. Impact of real-time CGM data sharing on quality of life in the caregivers of adults and children with type 1 diabetes. J Diabetes Sci Technol. (2022) 16:97–105. doi: 10.1177/1932296820978423
8. Ku CW, Zheng RT, Tan HY, Lim JYQ, Chen LW, Cheung YB, et al. Early continuous glucose monitoring-derived glycemic patterns are associated with subsequent insulin resistance and gestational diabetes mellitus development during pregnancy. Diabetol Metab Syndr. (2024) 16:271. doi: 10.1186/s13098-024-01508-4
9. Zheng Y, Campbell Rice B, Melkus GD, Sun M, Zweig S, Jia W, et al. Dietary self-management using mobile health technology for adults with type 2 diabetes: A scoping review. J Diabetes Sci Technol. (2023) 17:1212–25. doi: 10.1177/19322968231174038
10. Zeevi D, Korem T, Zmora N, Israeli D, Rothschild D, Weinberger A, et al. Personalized nutrition by prediction of glycemic responses. Cell. (2015) 163:1079–94. doi: 10.1016/j.cell.2015.11.001
11. Gottfried S, Pontiggia L, Newberg A, Laynor G, and Monti D. Continuous glucose monitoring metrics for earlier identification of pre-diabetes: protocol for a systematic review and meta-analysis. BMJ Open. (2022) 12:e061756. doi: 10.1136/bmjopen-2022-061756
12. Ehrhardt N and Al Zaghal E. Behavior modification in prediabetes and diabetes: potential use of real-time continuous glucose monitoring. J Diabetes Sci Technol. (2019) 13:271–5. doi: 10.1177/1932296818790994
13. Flockhart M and Larsen FJ. Continuous glucose monitoring in endurance athletes: interpretation and relevance of measurements for improving performance and health. Sports Med. (2024) 54:247–55. doi: 10.1007/s40279-023-01910-4
14. Dimova R, Chakarova N, Daniele G, Bianchi C, Dardano A, Del Prato S, et al. Insulin secretion and action affect glucose variability in the early stages of glucose intolerance. Diabetes Metab Res Rev. (2022) 38:e3531. doi: 10.1002/dmrr.3531
15. Beaudry KM and Devries MC. Nutritional strategies to combat type 2 diabetes in aging adults: the importance of protein. Front Nutr. (2019) 6:138. doi: 10.3389/fnut.2019.00138
16. Karakas SE. Reactive hypoglycemia: A trigger for nutrient-induced endocrine and metabolic responses in polycystic ovary syndrome. J Clin Med. (2023) 12:7252. doi: 10.3390/jcm12237252
17. Hermanns N, Ehrmann D, Kulzer B, Klinker L, Haak T, and Schmitt A. Somatic and mental symptoms associated with dysglycaemia, diabetes-related complications and mental conditions in people with diabetes: Assessments in daily life using continuous glucose monitoring and ecological momentary assessment. Diabetes Obes Metab. (2025) 27:61–70. doi: 10.1111/dom.15983
18. Ly TT, Hewitt J, Davey RJ, Lim EM, Davis EA, and Jones TW. Improving epinephrine responses in hypoglycemia unawareness with real-time continuous glucose monitoring in adolescents with type 1 diabetes. Diabetes Care. (2011) 34:50–2. doi: 10.2337/dc10-1042
19. Tatulashvili S, Baptiste Julla J, Sritharan N, Rezgani I, Levy V, Bihan H, et al. Ambulatory glucose profile according to different phases of the menstrual cycle in women living with type 1 diabetes. J Clin Endocrinol Metab. (2022) 107:2793–800. doi: 10.1210/clinem/dgac443
20. Ji SH, Dong C, Chen R, Shen CC, Xiao J, Gu YJ, et al. Effects of variability in glycemic indices on longevity in chinese centenarians. Front Nutr. (2022) 9:955101. doi: 10.3389/fnut.2022.955101
21. Basiri R and Cheskin LJ. Personalized nutrition therapy without weight loss counseling produces weight loss in individuals with prediabetes who are overweight/obese: A randomized controlled trial. Nutrients. (2024) 16:2218. doi: 10.3390/nu16142218
22. Zaharieva DP, Turksoy K, McGaugh SM, Pooni R, Vienneau T, Ly T, et al. Lag time remains with newer real-time continuous glucose monitoring technology during aerobic exercise in adults living with type 1 diabetes. Diabetes Technol Ther. (2019) 21:313–21. doi: 10.1089/dia.2018.0364
23. Randine P, Pocs M, Cooper JG, Tsolovos D, Muzny M, Besters R, et al. Privacy concerns related to data sharing for european diabetes devices. J Diabetes Sci Technol. (2025) 19:611–9. doi: 10.1177/19322968231210548
Keywords: continuous glucose monitoring, diabetes, diabetes management, personalized nutrition, glycemic variability, metabolic health
Citation: Xiao J (2025) Editorial: Continuous glucose monitoring: beyond diabetes management. Front. Endocrinol. 16:1678600. doi: 10.3389/fendo.2025.1678600
Received: 03 August 2025; Accepted: 05 August 2025;
Published: 21 August 2025.
Edited and reviewed by:
Åke Sjöholm, Gävle Hospital, SwedenCopyright © 2025 Xiao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Jianzhong Xiao, eGp6YTAxMTUwQGJ0Y2guZWR1LmNu