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Tuesday, October 26 • 2:45pm - 3:00pm
Diabetes Management in Underserved Communities: Data-Driven Insights from Continuous Glucose Monitoring

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Technical Presentations Group 4: Healthcare

I. MOTIVATION

Continuous glucose monitoring (“CGM”) has proven itself to be beneficial for people with diabetes, providing real-time feedback and clear glucose targets for patients. Unfortunately, we have supporting evidence almost exclusively from White individuals living with type 1 diabetes who are well-educated and can afford health insurance. There is limited understanding of CGM utility for people with type 2 diabetes (“T2D”). This is a massive gap, given T2D accounts for 90-95% of all diabetes cases. This gap is further intensified by two factors. One, there are negligible studies on CGM use in underserved communities, including racial/ethnic minorities who bear a disproportionate burden of the disease. Two, current CGM guidelines are based on summary statistics that smooth out the effect of potentially prognostic glucose patterns observed at different times of the day. We propose a fine-grained analysis of CGM data to discover clinically meaningful physiological and behavioral insights on T2D. These insights can then help design more effective and affordable treatments, which can significantly benefit underserved communities.

II.  HYPOTHESIS

CGMs capture glucose readings every 15 minutes, providing high-resolution temporal information that may detect diabetes onset and progression. Based on prior clinical research on T2D progression, we hypothesize that increasing diabetes risk is associated with: (i) increased glucose abnormalities with distinct patterns during the day vs. overnight, and (ii) bigger glucose surges after meals, most clearly observable after breakfast.

III. METHODS AND RESULTS

We analyzed 2 weeks of CGM data from 119 participants from an underserved community in Santa Barbara, CA (predominantly Hispanic/Latino females, 54·4 ±12·1 years old) stratified into three groups of increasing diabetes risk: (i) 35 normal but at risk of T2D (“at-risk”), (ii) 49 with prediabetes (“pre-T2D”), and (iii) 35 with T2D.

Overnight vs. rest of the day analysis: T2D participants spent significantly higher time in the elevated glucose range of 140-180 mg/dL throughout the day than at-risk and pre-T2D individuals (p<0.0001). Pre-T2D participants, interestingly, spent higher time between 140-180 mg/dL compared to at-risk individuals during the day (p<0.01) but not overnight.

Breakfast analysis: T2D participants had more prominent and more prolonged glucose peaks than the other two groups, with significantly greater height and duration of breakfast glucose peaks than at-risk and pre-T2D participants (p<0.0001 and p<0.01, respectively).

IV. CONCLUSION

We observed a distinct progression of glucose abnormality in a cohort of predominantly Hispanic/Latino individuals at-risk of T2D, those with pre-T2D, and those with T2D. Our results suggest that: (i) disease progression is initially associated with greater glucose excursions during the day and then eventually overnight; and (ii) Glucose peaks after breakfast become taller and take longer to attain with increasing diabetes severity. Both sets of results provide a CGM-based approach to monitoring diabetes progression at home. In the future, we need to validate our findings in longer-duration studies and other populations. Nevertheless, the proposed data-driven measures have the potential to detect diabetes onset early and offer opportunities for new pharmacological and non-pharmacological diabetes treatment regimens that can better benefit underserved communities disproportionately burdened with the disease.

Authors: Souptik Barua (Rice University), Namino Glantz (Sansum Diabetes Research Institute), David Kerr (Sansum Diabetes Research Institute) and Ashutosh Sabharwal (Rice University)

Speakers
SB

Souptik Barua

Rice University


Tuesday October 26, 2021 2:45pm - 3:00pm CDT

Attendees (1)