Use of Continuous Glucose Monitoring in Non-diabetic Individuals for Cardiovascular Prevention: A Systematic Review...

Cardiovascular disease (CVD) is a leading global cause of mortality, with prevention through lifestyle modification being paramount. Continuous glucose monitoring (CGM), which provides real-time, dynamic glycemic data, is increasingly being explored in non-diabetic populations to guide lifestyle interventions. This systematic review aims to synthesize the evidence on the use of CGM in non-diabetic individuals for guiding lifestyle modifications and assess its impact on cardiovascular risk prevention. A systematic literature search was conducted in PubMed/MEDLINE, Embase, Scopus, Web of Science, and ClinicalTrials.gov from January 2020 to August 2025. Studies investigating CGM-guided lifestyle interventions in non-diabetic adults and reporting cardiovascular risk factors or metabolic outcomes were included. Study selection, data extraction, and risk of bias assessment (using Cochrane Risk of Bias 2 (RoB 2) for randomized controlled trials (RCTs) and Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) for non-randomized studies) were performed by independent reviewers. A narrative synthesis was conducted due to study heterogeneity. Seven studies were included. CGM was used to personalize exercise timing, such as initiating walking before an individual's postprandial glucose peak, which significantly reduced postprandial glucose, insulin, and C-peptide levels. CGM also served as a motivational tool, increasing readiness for physical activity. Observational studies demonstrated CGM's ability to identify subclinical dysregulation in conditions like menopause and obstructive sleep apnea, linking higher glycemic variability to surrogate markers of cardiovascular risk, such as blood pressure variability. The overall risk of bias was low for six studies and serious for one, primarily due to confounding. Direct evidence on changes in traditional cardiovascular risk factors was limited. CGM shows promise for personalizing lifestyle interventions and improving glycemic outcomes in non-diabetic individuals, which are key surrogates for cardiovascular risk. Its utility lies in optimizing physical activity timing, enhancing motivation, and identifying at-risk metabolic phenotypes. However, evidence of a direct impact on hard cardiovascular endpoints remains limited. Future long-term trials should focus not on reaffirming the established link between glycemic variability and cardiovascular risk but on evaluating whether CGM-guided behavioral interventions offer a cost-effective and sustainable approach to enhancing cardiovascular prevention strategies in non-diabetic populations.