MON-669 - Continuous Glucose Monitoring-Enabled Lifestyle Medicine for Precision Prevention and Non-Pharmacologic Management of Prediabetes and Type 2 Diabetes

Background
Prediabetes and early type 2 diabetes (T2D) frequently progress despite guideline-directed lifestyle counseling and pharmacologic therapy. Traditional Diabetes Prevention Programs (DPPs) rely on standardized recommendations and retrospective glycemic metrics, limiting personalization and obscuring clinically relevant glucose excursions. Lifestyle Medicine (LM), structured around six pillars (nutrition, physical activity, restorative sleep, stress management, avoidance of risky substances, and social connection), addresses behavioral drivers of dysglycemia but is rarely guided by real-time physiological data. Continuous glucose monitoring (CGM) offers a novel opportunity to individualize non-pharmacologic diabetes prevention through metabolic feedback.

Objective
To evaluate the feasibility and clinical relevance of integrating CGM into a specialist-directed LM program for prevention and non-pharmacologic management of prediabetes and early T2D.

Methods
Adults with prediabetes or T2D who were enrolled in an integrated LM pilot embedded within specialty cardiometabolic care. Participants completed structured lifestyle assessments and received individualized interventions across all six LM pillars. CGM provided continuous real-time glucose data to patients and clinicians, enabling identification of postprandial glucose excursions, assessment of glycemic variability, and iterative refinement of lifestyle prescriptions. Outcomes included patient engagement, time-in-range, frequency and magnitude of glucose excursions, HbA1c trends, and patient-reported behavior change.

Results
CGM revealed substantial inter-individual heterogeneity in glycemic responses to food composition, meal timing, physical activity, sleep disruption, and psychosocial stress. Clinically meaningful glucose excursions were commonly observed despite HbA1c values within guideline-defined targets. Real-time CGM feedback enabled rapid, patient-driven lifestyle modification, resulting in reduced glycemic variability, improved time-in-range, and attenuation of postprandial spikes, frequently without medication initiation or escalation. Patients reported increased understanding of personal metabolic responses and greater adherence compared with prior standardized lifestyle counseling.

Conclusions
CGM-integrated, specialist-directed LM represents a feasible, precision-based, and practice-changing approach to preventing T2D and managing early dysglycemia without pharmacotherapy. By revealing glycemic risk not captured by HbA1c alone and enabling individualized intervention across all LM pillars, this supports a shift toward endocrinology-led, physiology-driven diabetes prevention; thus reducing disparities by individualizing prevention strategies and lowering educational barriers to metabolic self-management.

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*