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ZENODO
Preprint . 2025
License: CC BY
Data sources: ZENODO
ZENODO
Preprint . 2025
License: CC BY
Data sources: Datacite
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ÆTHER – Addendum B: Empirical Corroboration of Prediction S1 Using Real-World and Gold-Standard-Informed Data

Authors: Aufray, Vincent;

ÆTHER – Addendum B: Empirical Corroboration of Prediction S1 Using Real-World and Gold-Standard-Informed Data

Abstract

Auteur : Vincent Aufray Abstract Paper V of the ÆTHER framework predicted that increasing glucose variability constitutes an early-warning signal of metabolic instability preceding diabetes onset (Prediction S1), based on bifurcation theory and synthetic cohort validation (RR = 1.50). Here, we empirically corroborate Prediction S1 using two complementary approaches: (i) real-world cross-sectional data from NHANES 2017–2020, and (ii) a gold-standard-informed simulation calibrated to continuous glucose monitoring (CGM) literature. In NHANES (n = 3,138 adults without prevalent diabetes), glucose variability was conservatively estimated from the discrepancy between fasting glucose and HbA1c-derived mean glucose. Individuals with estimated CV ≥ 30% exhibited a markedly higher prevalence of prediabetes (HbA1c 5.7–6.4%), yielding a risk ratio RR = 2.36 [95% CI: 2.09, 2.65] and near-perfect discrimination (AUC = 0.945, p < 0.0001). Permutation testing confirmed that this association was not attributable to chance. To calibrate effect size under optimal measurement conditions, we generated a gold-standard-informed CGM simulation (n = 1,000, 14-day monitoring) with direct CV measurement. In this setting, elevated CV remained robustly associated with prediabetes (RR = 1.68 [1.55, 1.80], AUC = 0.739), consistent with longitudinal estimates reported in the literature (HR ≈ 1.5–2.0). Together, these results demonstrate that Prediction S1 survives progressively stricter measurement constraints, exhibiting a coherent effect-size gradient from synthetic proof-of-concept to empirical data and gold-standard-informed calibration. While causality cannot be inferred from cross-sectional or simulated data, this work provides strong empirical corroboration of S1 and motivates longitudinal validation using real CGM cohorts such as the UK Biobank.

Keywords

metabolic dysregulation, systems biology, non-circular validation, prediabetes, dynamical systems, Aether theory, bifurcation theory, robustness analysis, early warning signals, NHANES, continuous glucose monitoring, glucose variability, synthetic cohorts

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
0
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