Continuous glucose monitoring as a tool in early-stage type 1 diabetes

Abstract Continuous glucose monitoring (CGM) has transformed diabetes management by providing continuous, real-time insights into glucose dynamics, while enhancing the lived experience of individuals with type 1 diabetes. In established type 1 diabetes, CGM-derived measures of glucose management, such as time in range, time above range, time below range and glycaemic variability, have become integral tools to optimise therapy, reduce episodes of hypoglycaemia and guide clinical decision-making. More recently, CGM has emerged as a promising tool to detect early hyperglycaemia and other glucose abnormalities in individuals with early-stage type 1 diabetes, for whom current screening and staging methods, including fasting glucose, HbA 1c and the OGTT, remain limited by episodic sampling, participant burden and variable reproducibility. This review examines the rationale, evidence and practical considerations for integrating CGM into early-stage type 1 diabetes research and clinical frameworks. We discuss its potential to complement existing metabolic and immunological markers, as well as the technical, analytical and regulatory challenges that must be addressed for CGM to serve as a reliable tool for screening, staging and monitoring and as a clinical endpoint in early-stage type 1 diabetes. Graphical Abstract