(Boston)—Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are the clinical gold standards for screening for blood sugar levels yet they provide only static snapshots that fail to reflect the highly dynamic and heterogeneous nature of metabolic impairment. However, continuous glucose monitoring (CGM) is reshaping our understanding of these levels. While the medical community already has begun capitalizing on CGM for diabetes management, a new study has the potential to change current clinical practices for cardiovascular disease risk stratification in individuals without diabetes.
Researchers at Boston University Chobanian & Avedisian School of Medicine have found that glucose patterns captured by CGM devices among adults without diabetes are related to markers of cardiometabolic risk. The findings, published in Diabetes Care, could ultimately inform future approaches to identifying individuals at greater risk for poor cardiometabolic health.
"Understanding temporal glucose patterns may be pivotal in uncovering early or intermittent dysglycemia and its downstream cardiometabolic risks. Continuous glucose monitoring may aid this in characterizing the heterogeneity underlying dysglycemia by enabling phenotyping of individuals across the blood sugar continuum," explains corresponding author Nicole Spartano, PhD, assistant professor of medicine.
The researchers analyzed continuous glucose monitoring data from approximately 1,300 participants in the Framingham Heart Study who did not have diabetes or cardiovascular disease. They examined several features of glucose patterns, including average glucose, glucose variability and periods of higher glucose, and studied how these measures related to markers of cardiometabolic health.
They found that higher average glucose and higher percentage of time blood sugar exceeded 140 mg/dL are related to having higher risk of hypertension or cholesterol levels. The findings suggest, even among people without diabetes, glucose patterns may provide important insights into cardiometabolic health, including blood pressure and cholesterol levels. Ultimately, this work could inform future research aimed at diabetes and cardiovascular disease prevention, although additional studies are needed.
"Our findings align with a small but growing body of literature characterizing the cross-sectional associations of CGM measures and health outcomes. Emerging studies have also reported that higher percentage of time spent at glucose levels >140 mg/dL is longitudinally associated with the development of cardiometabolic outcomes, including type 2 diabetes, among individuals without type 2 diabetes," adds lead author Bahar Bakhshi, MS, a PhD candidate in the school's Molecular & Translational Medicine Program.
This investigation was supported by Framingham Heart Study contracts with the National Heart, Lung and Blood Institute (NHLBI) (N01-HC25195,HHSN268201500001I, and 75N92019D00031), with additional support from the National Institute of Diabetes and Digestive and Kidney Diseases (R01DK129305) (N.L.S.) and NHLBI (R01HL156975) (M.N.). B.B. is supported by a predoctoral fellowship from the American Heart Association (26PRE1564902). E.H. is supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (T32HD040128). Dexcom, Inc., provided CGM devices at a discounted rate.
