The northeast glucose drift: Stratification of post-breakfast dysglycemia among predominantly Hispanic/Latino adults at-risk or with type 2 diabetes

Abstract

Background There is minimal experience in continuous glucose monitoring (CGM) among underserved racial/ethnic minority populations with or at risk of type 2 diabetes (T2D), and therefore a lack of CGM-driven insight for these individuals. We analyzed breakfast-related CGM profiles of free-living, predominantly Hispanic/Latino individuals at-risk of T2D, with pre-T2D, or with non-insulin treated T2D.Methods Starting February 2019, 119 participants in Santa Barbara, CA, USA, (93 female, 87% Hispanic/Latino [predominantly Mexican-American], age 54¢4 [ §12¢1] years), stratified by HbA 1c levels into (i) at-risk of T2D, (ii) with pre-T2D, and (iii) with non-insulin treated T2D, wore blinded CGMs for two weeks. We compared valid CGM profiles from 106 of these participants representing glucose response to breakfast using four parameters.Findings A "northeast drift" was observed in breakfast glucose responses comparing at-risk to pre-T2D to T2D participants. T2D participants had a significantly higher pre-breakfast glucose level, glucose rise, glucose incremental area under the curve (all p < 0¢0001), and time to glucose peak (p < 0¢05) compared to pre-T2D and at-risk participants. After adjusting for demographic and clinical covariates, pre-breakfast glucose and time to peak (p < 0¢0001) were significantly associated with HbA 1c . The model predicted HbA 1c within (0¢55 § 0¢67)% of true laboratory HbA 1c values.Interpretation For predominantly Hispanic/Latino adults, the average two-week breakfast glucose response shows a progression of dysglycemia from at-risk of T2D to pre-T2D to T2D. CGM-based breakfast metrics have the potential to predict HbA 1c levels and monitor diabetes progression.

A probabilistic computation framework to estimate the dawn phenomenon in type 2 diabetes using continuous glucose monitoring

“…In particular, accurately timing the start of breakfast is vital to calculating the nocturnal glucose rise, and therefore the dawn phenomenon accurately. In this study, and based on previous work, a rule-based breakfast detection algorithm was applied which depends on observer assessment of CGM profiles 21 . More accurate and objective breakfast detection, through use of adaptive machine learning algorithms or additional sensors 31 – 33 , can improve the reliability of our findings.…”

“…For each day of CGM, a semi-automated framework from a previous study was used 21 to identify the start of breakfast. The framework has a manual breakfast segment annotation stage followed by a rule-based framework to filter out non-breakfast segments.…”

Temporal changes in bio-behavioral and glycemic outcomes following a produce prescription program among predominantly Hispanic/Latino adults with or at risk of type 2 diabetes

“…In that study, the time between 70 and 140 mg/dL during the day was also significantly correlated with HbA 1c levels after adjusting for age, sex, BMI, and waist circumference. There is also evidence that using real-world post-breakfast glucose excursions might also provide novel insights into differences in glycemia when comparing these same groups (i.e., at risk, pre-T2D, and T2D) [ 33 ].…”

“…Previous studies have examined correlations between HbA 1c and CGM metrics [ 32 , 33 ]. In this analysis, comparing baseline with conclusion CGM profiles, there were no significant differences (except for a change in the time in range between 140 and 180 mg/dL, which improved over time).…”

Evaluation of Immunological Levels of IL-37, IL-38, and IL-17A in Iraqi Patients with Diabetic Foot Ulcers

“…The most commonly encountered micro-vascular complication of diabetes is diabetic neuropathy, with a prevalence of 50-60%; neuropathy may cause decreased nerve functions and nerve blood perfusion with persistent nerve damage. Diabetic peripheral neuropathy increases the development of foot ulceration risk (Barua et al, 2022). Interleukin IL-37 is also known as IL-1 family member 7 (IL-1F7).…”