Browsing by Author "Sato Imuro, Sandra Emi"

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    Evaluating HbA1c-to-average glucose conversion with patient-specific kinetic models for diverse populations
    (Springer Nature, 2024) Sato Imuro, Sandra Emi; Sabharwal, Ashutosh; Bevier, Wendy; Kerr, David
    The discrepancy between estimated glycemia from HbA1c values and actual average glucose (AG) levels has significant implications for treatment decisions and patient understanding. Factors contributing to the gap include red blood cell (RBC) lifespan and glucose uptake into the RBC. Personalized models have been proposed to enhance AG prediction accuracy by considering interpersonal variation. This study contributes to our understanding of personalized models for estimating AG from HbA1c. Utilizing data from seven studies (340 participants), including Hispanic/Latino populations with or at risk of non-insulin-treated type 2 diabetes (T2D), we examined kinetic features across cohorts. Additionally, the study simulated scenarios to understand data requirements for improving accuracy. Personalized approaches improved agreement between AG estimations and CGM-AG, particularly with four or more weeks of training CGM data. A multiple linear regression model using kinetic parameters and added clinical features was shown to improve the accuracy of personalized models further. As CGM usage extends beyond type 1 diabetes, there is growing interest in leveraging CGM data for clinical decision-making. Patient-specific models offer a valuable tool for managing glycemic status in patients with discordant HbA1c and AG values.
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    Temporal changes in bio-behavioral and glycemic outcomes following a produce prescription program among predominantly Hispanic/Latino adults with or at risk of type 2 diabetes
    (Elsevier, 2023) Sato Imuro, Sandra Emi; Sabharwal, Ashutosh; Conneely, Casey; Glantz, Namino; Bevier, Wendy; Barua, Souptik; Pai, Amruta; Larez, Arianna; Kerr, David
    In the United States (U.S.), consumption of fresh vegetables and fruits is below recommended levels. Enhancing access to nutritious food through food prescriptions has been recognized as a promising approach to combat diet-related illnesses. However, the effectiveness of this strategy at a large scale remains untested, particularly in marginalized communities where food insecurity rates and the prevalence of health conditions such as type 2 diabetes (T2D) are higher compared to the background population. This study evaluated the impact of a produce prescription program for predominantly Hispanic/Latino adults living with or at risk of T2D. A total of 303 participants enrolled in a 3-month observational cohort received 21 medically prescribed portions/week of fresh produce. A subgroup of 189 participants used continuous glucose monitoring (CGM) to assess the relationship between CGM profile changes and HbA1c level changes. For 247 participants completing the study (76% female, 84% Hispanic/Latino, 32% with T2D, age 56·6 ± 11·9 years), there was a reduction in weight (−1·1 [-1·6 to −0·6] lbs., p < 0.001), waist circumference (−0·4 [-1·0 to 0·6] cm, p = 0·007) and systolic blood pressure (SBP) for participants with baseline SBP >120 mmHg (−4·2 [-6·8 to −1·8] mmHg, p = 0·001). For participants with an HbA1c ≥ 7·0% at baseline, HbA1c fell significantly (−0·5 [-0·9 to −0·1] %, p = 0·01). There were also improvements in food security (p < 0·0001), self-reported ratings of sleep, mood, pain (all p < 0·001), and measures of depression (p < 0·0001), anxiety (p = 0·045), and stress (p = 0·002) (DASS-21). There was significant correlation (r = 0·8, p = 0·001) between HbA1c change and the change in average glucose for participants with worsening HbA1c, but not for participants with an improvement in HbA1c. In conclusion, medical prescription of fresh produce is associated with significant improvements in cardio-metabolic and psycho-social risk factors for Hispanic/Latino adults with or at risk of T2D.