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Continuous Glucose Monitoring Identifies Youth with Prediabetes at Risk for Glycemic Progression.

Natalie Segev1,2, Nancy A Crimmins1,2, Roohi Kharofa2,3

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Diabetes Technology & Therapeutics
|March 23, 2026
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Summary

Continuous glucose monitoring (CGM) metrics better predict glycemic progression in pediatric prediabetes than HbA1c alone. Time spent above 140 mg/dL on CGM is a key indicator of risk in obese youth.

Keywords:
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Area of Science:

  • Pediatric Endocrinology
  • Metabolic Health
  • Diabetes Research

Background:

  • Pediatric prediabetes is prevalent in youth with obesity.
  • Progression to type 2 diabetes is variable and not solely predicted by adiposity or HbA1c.
  • Youth-onset type 2 diabetes has a severe clinical course.

Purpose of the Study:

  • To characterize glycemic patterns in youth with prediabetes using continuous glucose monitoring (CGM).
  • To determine if baseline CGM metrics can identify youth at highest risk for HbA1c progression over 6 months.

Main Methods:

  • Prospective observational cohort study of 29 youth (10-18 years) with obesity and prediabetes (HbA1c 5.7%-6.4%).
  • 14-day CGM wear at baseline and follow-up assessments including HbA1c.
  • Analysis of CGM metrics using the R iglu package and multivariable regression models.

Main Results:

  • Most CGM metrics and HbA1c remained stable over 6 months; 32% regressed to normoglycemia.
  • Time spent above 140 mg/dL on CGM was the strongest independent predictor of higher follow-up HbA1c and worsening glycemic trajectory.
  • One participant progressing to diabetes showed markedly elevated CGM glycemic variability and hyperglycemia.

Conclusions:

  • CGM metrics demonstrated superior predictive ability for short-term glycemic progression compared to HbA1c in youth with prediabetes.
  • CGM is a valuable adjunctive tool for early risk stratification in pediatric prediabetes.
  • Identifying high-risk youth can inform targeted interventions to prevent type 2 diabetes onset.