Associations of continuous glucose monitor derived time in range and glycaemic variability with diet lifestyle and demographics

Kate M Bermingham; Harry Smith; Emma L Duncan; Javier Gonzalez; Ana M Valdes; Paul W Franks; Linda Delahanty; Hassan S Dashti; Richard Davies; George Hadjigeorgiou; Jonathan Wolf; Andrew T Chan; Tim D Spector; Sarah E Berry

doi:10.1038/s41467-026-70308-3

Associations of continuous glucose monitor derived time in range and glycaemic variability with diet lifestyle and demographics

Kate M Bermingham, Harry Smith, Emma L Duncan, Javier Gonzalez, Ana M Valdes, Paul W Franks, Linda Delahanty, Hassan S Dashti, Richard Davies, George Hadjigeorgiou, Jonathan Wolf, Andrew T Chan, Tim D Spector, Sarah E Berry

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Abstract

Continuous glucose monitors (CGMs) provide detailed glucose profiles, but their relevance to health outcomes in individuals without diabetes remains unclear. Here we assess time in range (TIR 3.9-5.6 and TITR 3.9-7.8) and glycaemic variability in individuals (N = 3,634; age 46 ± 12 y; 83% female; BMI 27 ± 6 kg/m²) from PREDICT 1 (NCT03479866), PREDICT 2 (NCT03983733), and PREDICT 3 (NCT04735835) without diabetes or prediabetes, and explore associations with demographic, diet, lifestyle, cardiometabolic markers, and predicted cardiovascular risk. Outcomes are non-pre-defined exploratory analyses. Higher TIR 3.9-5.6 is associated with lower HbA1c, OGTT glucose, carbohydrate intake, and higher protein intake. Sleep duration is inversely correlated with mean glucose. TIR 3.9-5.6 provided moderate discrimination for predicted ASCVD 10-year risk (AUC = 0.75). While CGM metrics show potential to capture some components of glycaemic physiology, longer-term health outcomes are required to demonstrate whether CGM monitoring has utility for health management in euglycaemic individuals.

Original language	English
Journal	Nature Communications
Early online date	27 Mar 2026
DOIs	https://doi.org/10.1038/s41467-026-70308-3
Publication status	E-pub ahead of print - 27 Mar 2026

Data Availability Statement

The study data can be released to bona fide researchers who submit a research proposal to [email protected]. All proposals will be reviewed by a sub-panel of the ZOE Scientific Advisory Board within four working weeks. To protect participant privacy, individual participant clinical data are not publicly available and cannot be deposited in public repositories. Proposals, researchers or institutions requesting data will be approved if they meet the standard criteria related to ethics, privacy and data protection regulations. Approved researchers are required to enter into a data-sharing agreement with ZOE.

Acknowledgements

This work was supported by ZOE Ltd and TwinsUK, which is funded by the Wellcome Trust, Medical Research Council, Versus Arthritis, European Union Horizon 2020, Chronic Disease Research Foundation (CDRF), ZOE Ltd and the National Institute for Health Research (NIHR) Clinical Research Network (CRN) and Biomedical Research Centre based at Guy’s and St Thomas’ NHS Foundation Trust in partnership with King’s College London. H.S.D. is supported by the National Institute of Health [grant number R00HL153795].

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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10.1038/s41467-026-70308-3Licence: CC BY-NC-ND

503800_2_merged_1770140133Accepted author manuscript, 13.7 MBLicence: CC BY

Cite this

Bermingham, K. M., Smith, H., Duncan, E. L., Gonzalez, J., Valdes, A. M., Franks, P. W., Delahanty, L., Dashti, H. S., Davies, R., Hadjigeorgiou, G., Wolf, J., Chan, A. T., Spector, T. D., & Berry, S. E. (2026). Associations of continuous glucose monitor derived time in range and glycaemic variability with diet lifestyle and demographics. Nature Communications. Advance online publication. https://doi.org/10.1038/s41467-026-70308-3

Bermingham, KM, Smith, H, Duncan, EL, Gonzalez, J, Valdes, AM, Franks, PW, Delahanty, L, Dashti, HS, Davies, R, Hadjigeorgiou, G, Wolf, J, Chan, AT, Spector, TD & Berry, SE 2026, 'Associations of continuous glucose monitor derived time in range and glycaemic variability with diet lifestyle and demographics', Nature Communications. https://doi.org/10.1038/s41467-026-70308-3

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abstract = "Continuous glucose monitors (CGMs) provide detailed glucose profiles, but their relevance to health outcomes in individuals without diabetes remains unclear. Here we assess time in range (TIR 3.9-5.6 and TITR 3.9-7.8) and glycaemic variability in individuals (N = 3,634; age 46 ± 12 y; 83\% female; BMI 27 ± 6 kg/m²) from PREDICT 1 (NCT03479866), PREDICT 2 (NCT03983733), and PREDICT 3 (NCT04735835) without diabetes or prediabetes, and explore associations with demographic, diet, lifestyle, cardiometabolic markers, and predicted cardiovascular risk. Outcomes are non-pre-defined exploratory analyses. Higher TIR 3.9-5.6 is associated with lower HbA1c, OGTT glucose, carbohydrate intake, and higher protein intake. Sleep duration is inversely correlated with mean glucose. TIR 3.9-5.6 provided moderate discrimination for predicted ASCVD 10-year risk (AUC = 0.75). While CGM metrics show potential to capture some components of glycaemic physiology, longer-term health outcomes are required to demonstrate whether CGM monitoring has utility for health management in euglycaemic individuals. ",

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Associations of continuous glucose monitor derived time in range and glycaemic variability with diet lifestyle and demographics

Abstract

Data Availability Statement

Acknowledgements

UN SDGs

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