Casey Means, a Stanford-trained physician and wellness influencer nominated by US President Donald Trump for surgeon general, is convinced the US is experiencing an epidemic of metabolic dysfunction — a crisis silently unfolding inside the cells of millions of Americans.
One solution, she says, is giving people a close-up view of that crisis. Coincidentally, Levels, a company she co-founded, sells a system that allows people to continuously track their blood glucose levels in real time. She claims this information can help people home in on food and lifestyle choices that will improve their metabolic health.
It’s a philosophy that other "Make America Healthy Again" movement members have pushed. Health and Human Services Secretary Robert F. Kennedy Jr. extolled glucose monitoring devices as only costing “$80 a month, and they’ve been shown to be extraordinarily effective in helping people lose weight and avoid diabetes.” Meanwhile, Food and Drug Administration Commissioner Marty Makary told senators at his confirmation hearing that glucose monitors should not require a prescription. He similarly talked up their promise to address obesity and prevent diabetes.
There’s just one problem: These claims aren’t backed by science. They promise to lead Americans down a path to wellness but, without more evidence, could amount to a waste of our health care dollars.
“What is the utility there? The answer is zero,” says David Nathan, a Harvard Medical School professor who has led some of the most important studies on diabetes prevention. “This, to me, is a scam.”
In an information-rich age where our smartwatches can tell us the quality of our sleep, the number of steps we’ve taken, oxygen levels in our blood, heart rate and more, you might ask: Why not track blood sugar?
More data is not always better. It doesn’t always tell us something meaningful and, worse, could even cause harm by creating unnecessary anxiety or leading us to draw the wrong conclusions about our health.
Continuous glucose monitoring, or CGM, has allowed people with Type 1 diabetes to better manage their blood sugar, which, in turn, can lead to fewer serious health complications like blindness, kidney failure and even death. People with Type 2 diabetes have also used CGM to prevent dangerous fluctuations in blood sugar, but the data is mixed on the long-term benefits.
And then there’s CGM in people who don’t have diabetes.
Levels is one of several companies that charge anywhere from $199 to more than $400 per month for CGM, which is often paired with diet coaching.
“I believe CGM is the most powerful technology for generating the data and awareness to rectify our Bad Energy crisis in the Western world,” Means wrote in a blog post on her company’s website. Tracking glucose can “alert us to early dysfunction, coach us on how to eat and live in a way that promotes Good Energy in our unique bodies, and promote accountability.”
In reality, the data supporting constantly monitoring blood sugar in people who don’t have diabetes, and even in those with prediabetes, is virtually nonexistent, Nathan says. One 2024 review of the literature on CGM in healthy people found scant evidence of its utility. The authors found the research gaps so significant that they concluded any commercial products claiming to offer a benefit “be labeled as misleading.”
Means, meanwhile, has argued that CGM offers important information about our metabolic health. “An extra-large spike after a meal is a clear sign that the meal had too much refined grain or refined sugar and is creating a big stress of food energy for your cells to deal with,” she wrote on the company’s website.
But blood glucose is influenced by so much more than the last thing you ate, says Nicola Guess, a dietician and diabetes researcher at the University of Oxford. That includes whether you just finished a vigorous workout, slept poorly the night before, your stress levels, what other foods you ate recently or alongside a particular fruit or vegetable — even a woman’s menstrual cycle.
Moreover, doctors don’t even have enough data to tell patients what a “healthy” glucose fluctuation looks like in people without diabetes. We don’t know, for example, if a spike after a meal is harmless if it comes back down soon after, or even what “soon” would mean, says Nicole Spartano, a diabetes researcher at Boston University.
“I do worry that people have this technology and are making changes to their diet that do not truly improve their health,” Spartano says. “For example, you could eat hot dogs (with no bun) for every meal, and your glucose data would look perfect. Very few people would suggest that is a good diet.”
Similarly, there’s little evidence that blood sugar tracking can prompt people to make long-term changes in their habits, which is the foundational tenet of companies like Levels. Studies of evidence-backed lifestyle interventions show that many can elicit short-term benefits. It’s the long haul that people struggle with.
The influx of companies pushing CGM has prompted a more intense study of its value in healthy or prediabetic people. But we’re still years away from definitive answers.
The MAHA movement likes to say it’s about following “gold-standard science.” For people with diabetes, blood sugar tracking is part of gold-standard care. But for everyone else? So far, there’s nothing to suggest this would be a wise way to spend our money.
Lisa Jarvis
Lisa Jarvis is a Bloomberg Opinion columnist. The views expressed here are the writer’s own. — Ed.
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