Fast variable selection for distributional regression with application to continuous glucose monitoring data

With the growing prevalence of diabetes and the associated public health burden, it is crucial to identify modifiable factors that could improve patients' glycemic control. In this work, we seek to examine associations between medication usage, concurrent comorbidities, and glycemic control, utilizing data from continuous glucose monitor (CGMs). CGMs provide interstitial glucose measurements, but reducing data to simple statistical summaries is common in clinical studies, resulting in substantial information loss. Recent advancements in the Frechet regression framework allow to utilize more information by treating the full distributional representation of CGM data as the response, while sparsity regularization enables variable selection. However, the methodology does not scale to large datasets. Crucially, variable selection inference using subsampling methods is computationally infeasible. We develop a new algorithm for sparse distributional regression by deriving a new explicit characterization of the gradient and Hessian of the underlying objective function, while also utilizing rotations on the sphere to perform feasible updates. The updated method is up to 10000-fold faster than the original approach, opening the door for applying sparse distributional regression to large-scale datasets and enabling previously unattainable subsampling-based inference. Applying our method to CGM data from patients with type 2 diabetes and obstructive sleep apnea, we found a significant association between sulfonylurea medication and glucose variability without evidence of association with glucose mean. We also found that overnight oxygen desaturation variability showed a stronger association with glucose regulation than overall oxygen desaturation levels.