Riemannian manifold-based geometric clustering of continuous glucose monitoring to improve personalized diabetes management

Background: Continuous Glucose Monitoring (CGM) provides a detailed representation of glucose fluctuations in individuals, offering a rich dataset for understanding glycemic control in diabetes management. This study explores the potential of Riemannian manifold-based geometric clustering to analyze and interpret CGM data for individuals with Type 1 Diabetes (T1D) and healthy controls (HC), aiming to enhance diabetes management and treatment personalization.

Methods: We utilized CGM data from publicly accessible datasets, covering both T1D individuals on insulin and HC. Data were segmented into daily intervals, from which 27 distinct glycemic features were extracted. Uniform Manifold Approximation and Projection (UMAP) was then applied to reduce dimensionality and visualize the data, with model performance validated through correlation analysis between Silhouette Score (SS) against HC cluster and HbA1c levels.

Results: UMAP effectively distinguished between T1D on daily insulin and HC groups, with data points clustering according to glycemic profiles. Moderate inverse correlations were observed between SS against HC cluster and HbA1c levels, supporting the clinical relevance of the UMAP-derived metric.

Conclusions: This study demonstrates the utility of UMAP in enhancing the analysis of CGM data for diabetes management. We revealed distinct clustering of glycemic profiles between healthy individuals and diabetics on daily insulin indicating that in most instances insulin does not restore a normal glycemic phenotype. In addition, the SS quantifies day by day the degree of this continued dysglycemia and therefore potentially offers a novel approach for personalized diabetes care.