12596 Characterizing Glycemic Variability In Novel Subphenotypes Of Individuals At Elevated Risk For Type 2 Diabetes Using Continuous Glucose Monitoring

Abstract

Abstract Disclosure: A.J. Kretowski: None. P. Konopka: None. A. Janucik: None. A. Citko: None. A. Paszko: None. M. Klak: None. A. Golonko: None. A. Szklaruk: None. L. Szczerbinski: None. Background: The heterogeneity among individuals at elevated risk for Type 2 Diabetes (T2D) recently has led to the identification of six subphenotypes, each with distinct risks for developing T2D, its complications, and mortality. Our study leveraged Continuous Glucose Monitoring (CGM) to offer a detailed characterization of these subphenotypes, aiming to uncover differences in glycemic variability and control. Methods: CGM data from 616 individuals without diabetes, from the Polish Registry of Diabetes (PolReD) study, classified into six clusters, were analyzed. The PolReD used Freestyle Libre 2 (Abbott) as the CGM device. CGM-derived measures of glucose control and glucose variability were calculated using the iglu R package. We utilized Analysis of Variance (ANOVA) and Analysis of Covariance (ANCOVA), adjusting for age and sex, to identify significant differences in CGM parameters across the clusters. Results: Our analysis identified significant differences in several CGM-derived parameters among the clusters, notably in the Glycemic Risk Assessment Diabetes Equation (GRADE), Standard Deviation of weekly glucose values (SDw), Mean Amplitude of Glycemic Excursions (MAGE), Maximum glucose value, Glucose range, and Mean Absolute Glucose (MAG). Clusters 3 and 5, characterized by beta-cell dysfunction and high insulin resistance respectively, and associated with the highest risk of T2D, exhibited the greatest glucose variability, with elevated risk for glycemic excursions. In contrast, Cluster 4, indicative of a metabolically healthy obesity profile with a low risk of T2D, demonstrated the most stable glycemic control and the lowest variability among the clusters. Conclusions: This study shows that subtypes of patients at elevated risk for T2D exhibit distinct patterns in CGM-derived parameters, indicating variations in glucose control and stability that extend beyond traditional fasting and post-challenge glucose assessments. Notably, we found that subtypes facing the highest T2D risk display increased glycemic variability, despite their differing underlying mechanisms of dysglycemia. These findings highlight the utility of CGM as a tool for identifying individuals at an increased risk of T2D, reducing the need for extensive phenotyping typically required for cluster assignment. Presentation: 6/1/2024