Key Findings
Average glucose serves as a more precise marker for metabolic health in adults without diabetes than HbA1c. In a study of 7,930 participants with laboratory data, average glucose tracked insulin resistance, triglycerides, HDL cholesterol, uric acid, and C-reactive protein more closely than HbA1c. Notably, average glucose explained nearly three times more variance in fasting insulin (R² 0.131 vs 0.048).
Technical Details
The study utilized data from 62,122 free-living adults on the Levels digital-health platform, finding that average glucose was the most reliable measure across weeks with an intraclass correlation of 0.747. The researchers identified a significant link between average glucose levels and occult hyperinsulinemia (defined as fasting insulin ≥10 µIU/mL) in individuals with normal HbA1c: the prevalence was 27.5% for those with average glucose ≥110 mg/dL, compared to 12.6% for those below that threshold.
Analysis of glucose spikes revealed that spike width—rather than spike height or frequency—tracked insulin resistance, triglycerides, and C-reactive protein. While carbohydrate sensitivity was found to be reliable, it did not track insulin resistance.
Background & Context
The utility of continuous glucose monitoring (CGM) for non-diabetic adults has been contested because CGM metrics were originally designed for diabetes management, and standard screening typically relies on HbA1c. This cross-sectional study sought to determine if CGM provides actionable metabolic information for the general population.
Significance & Outlook
These results suggest a new framework for interpreting CGM data in adults without diabetes, highlighting that traditional markers like HbA1c may miss hidden metabolic risks. The study provides a basis for using average glucose and spike width to identify occult hyperinsulinemia and other metabolic dysfunctions in free-living populations.
Source: https://doi.org/10.64898/2026.11.03.26367126
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