The evidence is convergent. Multiple independent sources reach the same conclusion, the underlying mechanism is well-characterized, and even the field's most cautious voices treat it as worth doing.
Or better yet, put a CGM on and prove it to yourself. You can see, and we'll go through all this at the end of the podcast, the CGM will tell you what your average blood sugar is over the time you're wearing it, and you can correlate that with your hemoglobin A1C, um, and get a more accurate sense.
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When you put these things on patients for 90 days you actually find out what their average blood glucose is you then compare that to the imputed average blood glucose from hemoglobin a1c and if 25% of our patients are concordant that's pretty good 75% are discordant and it could be in either direction
you realize this test is helpful when comparing the difference between someone who's at 5.1 verses 8.1 it offers no fidelity between five and six in my opinion such an important point you brought up because I have patients that come in and we've made incredible transformations on every metric but they literally look at their blood reports these are very motivated South Asians who are very focused on numbers and grades and they're like I'm still not getting that a1c down I'm not getting that fasting glucose down to 99 and they obsess over that Peter they're like do I need to go more low-carb do I need to workout harder and and it's just a matter of listen metabolically by my definition you're healthy let's not obsess over this number and focus on bigger things
I think average blood glucose is still the most important metric we care about um because that's the one for which we have the most data in other words we know all cause mortality data as as it relates to hemoglobin A1c hemoglobin A1c is a measurement that's used to impute average blood glucose so this is a very very close proxy when we can see average blood glucose on CGM even though it's not the same as measuring A1C it's very difficult to argue that knowing your average blood glucose on CGM and knowing your A1C aren't highly comparable and therefore by proxy the lower your average blood glucose on CGM the lower your all-cause mortality because it is abundantly clear that the lower your hemoglobin A1c even outside of the diabetic range the lower your all-cause mortality
Post-meal glucose spikes in non-diabetics drive long-term cardiometabolic disease independently of HbA1c.
Wearing a continuous glucose monitor leads to personalized dietary improvements that hold up beyond 12 weeks.
Continuous glucose monitors meaningfully change behavior in non-diabetic adults beyond the first month.
CGM use in metabolically healthy adults induces orthorexic-style dietary anxiety without health benefit.