Researchers Find That CGMs Provide Insight On The Progression Of Type 2 Diabetes Among Hispanic Adults
Continuous glucose monitors (CGMs) have been used for diabetes management since 1999. Despite having been around for two decades, existing CGM research has only focused on predominately white participants living with type 1 diabetes. Recognizing the need for more CGM research focused on minority populations and its impact on people with type 2 diabetes, researchers from the Sansum Diabetes Research Institute (SDRI) and Rice University launched a study to investigate the role that CGMs play in understanding type 2 diabetes progression among Hispanic adults.
“In the United States, diabetes disproportionately impacts minority populations,” David Kerr, MD, director of research and innovation at the Sansum Diabetes Research Institute based in Santa Barbara, California tells Beyond Type 1. “Living on the central coast of California, where more than 46 percent of the population are from the Hispanic, Latino community, there is data showing that rates of diabetes and the associated complications are more common compared to the general population in the United States,” Kerr says. According to the U.S. Department of Health and Human Services Office of Minority Health, Hispanics are 70 percent more likely than non-Hispanic white adults to be diagnosed with type 2 diabetes and 1.3 times more likely than non-Hispanic whites to die, underscoring the importance of diabetes-related technology utilization among Hispanics with diabetes.
The study followed 100 participants with type 2 diabetes or had self-reported as at risk for developing type 2. Eighty-six percent of participants were Hispanic. After enrollment, all study participants were trained to wear the Abbott Freestyle Libre Pro CGM device for 14 days. After two weeks, participants returned their sensors. Upon return, the CGM readers were connected to libreview.com, where an individualized report was created.
Health Impact of CGM Usage
The study found a strong relationship between the time spent in 3.9 to 7.8 mmol/L70 to 140 mg/dL range throughout the day with a healthy HbA1c, compared to the overnight time spent, which had a weaker correlation. “This shows the importance of focusing closely on the time in range during the day to estimate more accurately which way your HbA1c is going,” Souptik Barua, PhD, postdoctoral research associate in the electrical and computer engineering department at Rice University tells Beyond Type 1.
“For the pre diabetes participants, we saw that their glucose profiles remained stable within the target 3.9 to 7.8 mmol/L70 to 140 mg/dL. During the day, they had started to deviate,” Barua says. “If we can monitor participants, people with prediabetes, we can see that their blood glucose readings during the day are spiking to those kinds of ranges.”
He adds that CGMs have allowed researchers to collect blood glucose level fluctuations, informing researchers about a patient’s glucose profile and current health status. “That can tell us something about whether a participant is becoming worse or not,” Barua says.
The utilization of diabetes-related technology such as CGMs have improved HbA1c and quality of life. Barua explains that if patients and physicians can look at blood glucose data more closely, they can understand how diabetes is progressing, ultimately, informing intervention.
Albeit the health benefits of CGM usage, CGMs are underutilized and inaccessible, especially by communities of color. A research study published in Diabetes Care found that in California, there were statistically significant differences in CGM use by race. For example, only 21.1 percent of Hispanic participants have used CGMs when compared to 57.9 percent usage among non-Hispanic white participants. Similar numbers are reflected in a study conducted by Dr. Shivani Agarwal, which found disparate CGM use among youth—53 percent of non-Hispanic youth used CGM, versus 31 percent of non-Hispanic Black youth. And throughout the pandemic, one in five people have postponed or delayed purchasing CGMs due to financial constraints.
The most pervasive barrier for technology and CGM use was located at the provider and system levels. The study found that endocrinologists had overtly blocked or discouraged CGM use and belittled or demeaned patients. Participants also reported not having the financial resources to continue using CGMs, and despite having health insurance, insurance plans did not cover CGMs for participants. The Diabetes Care study also found that participants noted that the technology was too difficult to use.
One way to make CGMs accessible is through digital literacy, says Barua. “For me, it’s easy to understand what all the different numbers that come out from the data mean. But it’s important to communicate in a proper way,” Barua says. “So we intend to further research different strategies for effective visualization, pictures, graphics that can be more understood by communities and participants who may not have high levels of digital literacy or numeracy.”
Barua explains that making the data more understandable can also inform the process for prescribing the right intervention or treatment.