JMIR Publications

ABSTRACT

Background:

Conventional clinical markers guide cardiovascular risk stratification; however, continuous glucose monitoring (CGM) data remain absent from prediction models. A synthesis of the current literature is needed to clarify the prognostic relevance of CGM data for cardiovascular outcomes in people with diabetes.

Objective:

This scoping review aimed at identify published studies examining (1) associations between glycemic control and cardiovascular outcomes, and (2) the predictive value of CGM-derived metrics in cardiovascular risk assesment.

Methods:

MEDLINE and Embase were searched from inception to March 11, 2025 for peer-reviewed, original research that included CGM-derived metrics and cardiovascular disease outcomes. Two reviewers screened records independently.

Results:

The 53 included studies focused on either type 1 diabetes, type 2 diabetes, both diabetes types, or prediabetes. Clinical outcomes were examined in 16 studies, while 40 studies examined subclinical outcomes. Most studies were cross-sectional, except six longitudinal studies. All studies were association studies, and three included secondary analyses of predictive performance. No studies applied machine learning-based methods. A wide range of CGM-derived metrics were studied in the literature.

Conclusions:

Overall, findings were inconsistent across studies, likely due to methodological weaknesses such as underpowered analysis. Only the mean amplitude of glycemic excursions was consistently associated with cardiovascular disease, but time-in-range (TIR), which was both the most studied metric, was also associated with cardiovascular risk in the largest single study. The prognostic value of CGM-derived metrics for CVD outcomes is currently underexplored. Longitudinal prediction studies on clinical CVD outcomes, leveraging the potential of routinely collected CGM data, are needed.