Continuous glucose monitoring as a tool in early-stage type 1 diabetes – published online 09/03/2026

Alice L. J. Carr, Hannah Sutton, Rikke M. Agesen, Ezio Bonifacio, Emanuele Bosi, Peter Gillard, Rabbi Swaby, Jurgen Vercauteren, Rachel E. J. Besser

Use of continuous glucose monitoring (CGM) is gaining traction in early-stage type 1 diabetes. In this issue, Carr and Sutton et al (https://doi.org/10.1007/s00125-026-06707-4) examine the rationale, evidence and practical considerations for integrating CGM into early-stage type 1 diabetes research and clinical care. The authors discuss how, despite the methodological and practical advantages of CGM, progress will depend on robust, age-specific reference values and confidence that metrics are comparable across devices and analytical pipelines. Lack of international standardisation in CGM device validation and comparator methodology remains a major barrier. Uncertainties also persist around optimal wear strategies, acceptability and cost-effectiveness at scale. The authors argue that CGM is best positioned as a complementary tool enabling more frequent surveillance when paired with immunological and metabolic markers. They conclude that defining reproducible and clinically meaningful thresholds, establishing device-agnostic analytical standards, and generating prospective evidence within biomarker qualification frameworks will determine whether glucose dynamics can be elevated from an exploratory signal to actionable endpoints in early-stage type 1 diabetes. The figures from this review are available as a downloadable slideset.