Glycemic variability and insulin resistance: A risk marker in adult males predisposed to diabetes mellitus.

BACKGROUND: Continuous glucose monitoring (CGM) is a modality that allows real time monitoring of changes in blood sugar levels, which is a sign of risk of getting diabetes mellitus (DM). This study looks at glycemic variability (GV) and how it relates to beta-cell dysfunction and insulin resistance in adult men who are at increased risk for DM as measured by the Indian Diabetes Risk Score (IDRS). METHODS: The study was an analytical cross-sectional pilot study. Over a period of 14 days, 60 nondiabetic men aged above 30 years with an IDRS of 30 or higher were monitored using the Abbott FreeStyle Libre CGM system. Various CGM-derived metrics [standard deviation (SD), coefficient of variation (CV), mean amplitude of glycemic excursions (MAGE), continuous overall net glycemic action (CONGA), lability index (LI), high blood glucose index (HBGI), and J-index] were studied and compared with homeostatic model assessment of insulin resistance (HOMA-IR) and homeostatic model assessment of beta cell function (HOMA-B). RESULTS: Participants showed elevated GV with a mean SD ± 28.5 mg/dL, CV 22.3%, and MAGE 65.2 mg/dL. High-risk IDRS (≥60) males had higher GV metrics (e.g. CONGA 89.1 vs. 87.8 mg/dL in medium-risk, p = 0.937) and HOMA-IR (7.9 vs. 4.1 in low GV, p < 0.001). However, group comparisons revealed no significant variations in LI or J-index. The GV metrics showed strong positive correlations with HOMA-IR (r = 0.834, p < 0.001) and weak negative correlations with HOMA-B (r = -0.310, p = 0.016). CONCLUSIONS: High GV, which can be detected by CGM, is common in men at high risk for DM and is associated with insulin resistance. These findings indicate that CGM could serve as a valuable tool for early risk stratification. Further large-scale studies are warranted to confirm these observations and assess their potential clinical relevance.