Clinical Value of HbA1c/ updated GMI Ratio in Identifying Early Retinopathy Risk in Type 1 Diabetes
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: Discrepancies between HbA1c and glucose management indicator (GMI) may reflect individual variations in glycation rate, independent of mean glycemia, and could influence complication risk stratification in type 1 diabetes (T1D). We evaluated the phenotype of individuals with T1D using continuous glucose monitoring (CGM), identified as high glycators based on HbA1c/ updated GMI ratio, and assessed retrospectively their risk of diabetic retinopathy (DR) and the time to DR diagnosis. The secondary aim was to identify clinical correlates of high glycation. Primary outcome: time to first diagnosis of DR. Secondary outcomes: clinical factors associated with high glycation. Methods: A retrospective study of 411 individuals with T1D using CGM and concurrent HbA1c values. Patients with conditions affecting red blood cell (RBC) lifespan were excluded. Participants were divided into 3 subgroups based on current HbA1c/ updated GMI ratio ≤0.95 (low glycators), >0.95 and <1.05 (concordant glycators), and ≥1.05 (high glycators). Time to diagnosis of DR was retrieved. Results: High glycation is associated with shorter time to first diagnosis of DR (adjusted hazard ratio 1.60). Non-HDL-C, RBC indices, and metformin were associated with high glycation. Conclusion: Among individuals with T1D, an HbA1c/ updated GMI ratio ≥1.05 is associated with higher odds of DR. Non-HDL-C and RBC indices are correlates of high glycation. These results underscore the relevance of HbA1c and updated GMI discrepancy in cardiometabolic risk assessment, but cutoffs remain to be set.
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7134257445