Dysglycemia in adults at risk for or living with non-insulin treated type 2 diabetes: Insights from continuous glucose monitoring.

Background: Continuous glucose monitoring (CGM) has demonstrable benefits for people living with diabetes, but the supporting evidence is almost exclusively from White individuals with type 1 diabetes. Here, we have quantified CGM profiles in Hispanic/Latino adults with or at-risk of non-insulin treated type 2 diabetes (T2D).
Methods: 100 participants (79 female, 86% Hispanic/Latino [predominantly Mexican], age 54·6 [±12·0] years) stratified into (i) at risk of T2D, (ii) with pre-diabetes (pre-T2D), and (iii) with non-insulin treated T2D, wore blinded CGMs for 2 weeks. Beyond standardized CGM measures (average glucose, glucose variability, time in 70-140 mg/dL and 70-180 mg/dL ranges), we also examined additional CGM measures based on the time of day.
Findings: Standardized CGM measures were significantly different for participants with T2D compared to at-risk and pre-T2D participants ( p <0·0001). In addition, pre-T2D participants spent more time between 140 and 180 mg/dL during the day than at-risk participants ( p <0·01). T2D participants spent more time between 140 and 180 mg/dL both during the day and overnight compared to at-risk and pre-T2D participants (both p <0·0001). Time in 70-140 mg/dL range during the day was significantly correlated with HbA _1c ( r =-0·72, p <0·0001), after adjusting for age, sex, BMI, and waist circumference ( p <0·0001).
Interpretation: Standardized CGM measures show a progression of dysglycemia from at-risk of T2D, to pre-T2D, and to T2D. Stratifying CGM readings by time of day and the range 140-180 mg/dL provides additional metrics to differentiate between the groups.
Funding: US Department of Agriculture (Grant #2018-33800-28404) and NSF PATHS-UP ERC (Award #1648451).
Competing Interests: DK reports non-financial support from Abbott Diabetes Care, during the conduct of the study; grants from Lilly, personal fees from Sanofi, personal fees from NovoNordisk, personal fees from Glooko, outside the submitted work. NG, CC, AL, and WB report non-financial support from Abbott Diabetes Care, grants from US Dept of Agriculture, during the conduct of the study; grants from Lilly, outside the submitted work. SB and AS declare no competing interest(s).
(© 2021 The Authors.)