Domain-based Basal and Daytime Ambulatory Glycemic Exposure Metrics Derived from Continuous Glucose Monitoring: A Real-world Clinic-based Study
Abstract
Background: Standard continuous glucose monitoring (CGM) metrics summarize whole-day exposure but do not explicitly localize glycemic burden to nocturnal basal and daytime ambulatory domains. Objective: The objective of this study was to evaluate time-normalized domain metrics across oral glucose tolerance test (OGTT)-derived phenotypes and assess their relationships with established CGM measures, robustness, reproducibility, and incremental information. Methods: We analyzed paired OGTT and FreeStyle Libre data from 253 clinic participants. CGM was partitioned into 00:00–<06:00 and 06:00–<24:00 domains. Area of basal glycemia (ABG) and area of prandial/daytime ambulatory glycemia (APG) quantified mean nocturnal and daytime exposure; incremental ABG (iABG)/incremental APG (iAPG) and deficit ABG/deficit APG quantified above- and below-anchor exposure relative to 80/90 mg/dL. Participant-level phenotype comparisons, correlations, alternative-anchor and time-window sensitivity analyses, split-period agreement, covariate-adjusted models, repeated cross-validation, and conventional-category analyses were performed. Results: Corrected phenotype counts were NoDM 9, increased IR 7, midzone glycemia 26, prediabetes 78, and diabetes 133. Mean ABG/APG increased from 80.45/86.38 mg/dL in NoDM to 112.17/124.99 mg/dL in diabetes. Phenotype effects were significant for ABG (ε2 = 0.266), APG (0.371), iABG (0.282), and iAPG (0.390; all P < 0.001). iAPG correlated with HbA1c (rho = 0.751), OGTT area under the curve glucose (0.742), mean CGM glucose (0.986), time above range >180 mg/dL (0.858), and time >140 mg/dL (0.955). Findings were stable across alternative anchors and ± 1-h windows; ICC (A, 1) was 0.795 for APG and 0.788 for iAPG. Associations persisted after adjustment for age, sex, and body mass index. Temporal-domain contrasts added only modest information beyond mean glucose and none after excluding diabetes. Conclusions: ABG/APG metrics reproducibly localize glycemic exposure to nocturnal and daytime domains. They complement rather than replace established whole-day CGM metrics and require prospective external validation and outcome benchmarking.
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BibTeX
@article{shinde2026domainbased,
title = {{Domain-based Basal and Daytime Ambulatory Glycemic Exposure Metrics Derived from Continuous Glucose Monitoring: A Real-world Clinic-based Study}},
author = {Suresh N. Shinde and Rituparna Suresh Shinde and Succhietra Yogesh Bhangaaley},
journal = {International Journal of Diabetes and Technology},
year = {2026},
month = oct,
doi = {10.4103/ijdt.ijdt_35_26},
url = {https://doi.org/10.4103/ijdt.ijdt_35_26},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - Domain-based Basal and Daytime Ambulatory Glycemic Exposure Metrics Derived from Continuous Glucose Monitoring: A Real-world Clinic-based Study
AU - Suresh N. Shinde
AU - Rituparna Suresh Shinde
AU - Succhietra Yogesh Bhangaaley
PY - 2026
DA - 2026/10/01
JO - International Journal of Diabetes and Technology
DO - 10.4103/ijdt.ijdt_35_26
UR - https://doi.org/10.4103/ijdt.ijdt_35_26
AB - Background: Standard continuous glucose monitoring (CGM) metrics summarize whole-day exposure but do not explicitly localize glycemic burden to nocturnal basal and daytime ambulatory domains. Objective: The objective of this study was to evaluate time-normalized domain metrics across oral glucose tolerance test (OGTT)-derived phenotypes and assess their relationships with established CGM measures, robustness, reproducibility, and incremental information. Methods: We analyzed paired OGTT and FreeStyle Libre data from 253 clinic participants. CGM was partitioned into 00:00–<06:00 and 06:00–<24:00 domains. Area of basal glycemia (ABG) and area of prandial/daytime ambulatory glycemia (APG) quantified mean nocturnal and daytime exposure; incremental ABG (iABG)/incremental APG (iAPG) and deficit ABG/deficit APG quantified above- and below-anchor exposure relative to 80/90 mg/dL. Participant-level phenotype comparisons, correlations, alternative-anchor and time-window sensitivity analyses, split-period agreement, covariate-adjusted models, repeated cross-validation, and conventional-category analyses were performed. Results: Corrected phenotype counts were NoDM 9, increased IR 7, midzone glycemia 26, prediabetes 78, and diabetes 133. Mean ABG/APG increased from 80.45/86.38 mg/dL in NoDM to 112.17/124.99 mg/dL in diabetes. Phenotype effects were significant for ABG (ε2 = 0.266), APG (0.371), iABG (0.282), and iAPG (0.390; all P < 0.001). iAPG correlated with HbA1c (rho = 0.751), OGTT area under the curve glucose (0.742), mean CGM glucose (0.986), time above range >180 mg/dL (0.858), and time >140 mg/dL (0.955). Findings were stable across alternative anchors and ± 1-h windows; ICC (A, 1) was 0.795 for APG and 0.788 for iAPG. Associations persisted after adjustment for age, sex, and body mass index. Temporal-domain contrasts added only modest information beyond mean glucose and none after excluding diabetes. Conclusions: ABG/APG metrics reproducibly localize glycemic exposure to nocturnal and daytime domains. They complement rather than replace established whole-day CGM metrics and require prospective external validation and outcome benchmarking.
SN - 2949-8457
ER -