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Lack of Association Between Hemoglobin A1c and Continuous Glucose Monitor Metrics Among Individuals with Prediabetes

Jorge A Rodriguez1,2, Nadine E Palermo2,3, Wenyu Song1,2

  • 1Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA.

Diabetes Technology & Therapeutics
|September 30, 2025
PubMed

Insights

Continuous glucose monitor (CGM) metrics do not reliably reflect hemoglobin A1c (HbA1c) in prediabetes or normoglycemia. Associations are strongest in type 2 diabetes, but weaken significantly in lower glycemic states.

Area of Science:

  • Endocrinology
  • Metabolic Health
  • Diabetes Technology

Background:

  • Continuous glucose monitors (CGMs) offer detailed glycemic insights.
  • The correlation between CGM metrics and hemoglobin A1c (HbA1c) in prediabetes and normoglycemia is not well-established.

Purpose of the Study:

  • To investigate the association between various CGM metrics and HbA1c across different glycemic statuses: type 2 diabetes, prediabetes, and normoglycemia.
  • To determine if standard CGM metrics can accurately reflect HbA1c levels in individuals without diabetes.

Main Methods:

  • Analysis of data from 972 individuals stratified by glycemic status (421 type 2 diabetes, 319 prediabetes, 232 normoglycemia).
  • Examined associations between eight CGM metrics and HbA1c using regression analysis.
  • Assessed interaction terms to evaluate differences across glycemic groups.

Main Results:

  • Strongest associations between CGM metrics and HbA1c were observed in the type 2 diabetes group, particularly mean glucose (standardized β = 0.79).
  • In prediabetes, associations were attenuated, with mean glucose showing a moderate relationship (standardized β = 0.22).
  • For normoglycemic individuals, CGM metrics showed minimal association with HbA1c, including a weak link with mean glucose (standardized β = 0.10) and no significant relationship for time in range.

Conclusions:

  • Standard CGM metrics should be interpreted cautiously and are not interchangeable with HbA1c measurements in individuals with prediabetes or normoglycemia.
  • Glycemic status significantly modifies the relationship between CGM-derived metrics and HbA1c.
  • Further research may be needed to establish appropriate interpretation guidelines for CGM data in non-diabetic glycemic states.

Keywords:
continuous glucose monitoringglycemic variabilityhemoglobin A1cnormoglycemiaprediabetes

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