Domain-based basal and daytime ambulatory glycemic exposure metrics derived from continuous glucose monitoring: a real-world clinic-based study
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Background
Consensus continuous glucose monitoring (CGM) metrics, including time in range (TIR), time above range (TAR), time below range (TBR), mean glucose, glucose management indicator, and glycemic variability, are essential for modern glucose assessment. However, these whole-day summaries do not explicitly partition nocturnal basal from daytime ambulatory glycemic burden.
Objective
To develop and evaluate a complementary domain-based CGM framework that quantifies basal and daytime ambulatory glycemic exposure across oral glucose tolerance test (OGTT)-derived dysglycemia phenotypes.
Methods
In this observational, clinic-based study, 253 individuals underwent OGTT with insulin measurement and CGM. Participants were classified using a prespecified OGTT-derived phenotyping algorithm, implemented through a deterministic rules-based web calculator, and collapsed into five groups: NoDM, Increased insulin resistance, Midzone Glycemia, Prediabetes, and Diabetes. CGM files were uniformly reprocessed by selecting the latest contiguous episode and retaining the most recent 15 calendar days with data. The 24-hour profile was partitioned into nocturnal basal (00:00 to <06:00) and daytime ambulatory (06:00 to <24:00) domains. Derived indices included Area of Basal Glycemia (ABG), Area of Prandial/Daytime Ambulatory Glycemia (APG), incremental ABG (iABG), incremental APG (iAPG), and exploratory deficit indices dABG and dAPG.
Results
The final dataset contributed 3,647 analyzable CGM days. APG remained higher than ABG across all groups. Mean ABG/APG increased from 80.45/86.38 mg/dL in NoDM to 111.96/124.70 mg/dL in Diabetes. Mean iABG/iAPG increased from 5.65/6.60 to 34.12/38.91 mg/dL, whereas dABG/dAPG declined as dysglycemia worsened.
Conclusions
The ABG/APG framework provides interpretable, domain-resolved CGM burden metrics that separate basal from daytime ambulatory exposure and distinguish total burden from above-threshold excess. These indices are proposed as adjunctive metrics to support dysglycemia phenotyping, early risk recognition, and treatment monitoring, but are not intended to replace established consensus CGM metrics or diagnostic criteria. External, prospective validation is required.
