Association Between the GMI / HbA1c Ratio and Microvascular Complications in Type 1 Diabetes: A Multicenter Cross‐Sectional Study
Year: 2026
Type: article
Study design: Observational Study
Abstract: OBJECTIVE: To clarify whether the glucose management indicator (GMI)/glycated haemoglobin (HbA1c) ratio (GMI/HbA1c ratio) is an independent predictor of microvascular complications in Type 1 diabetes (T1D). DESIGN AND METHODS: Multicentre, cross-sectional, observational study including subjects with T1D with at least 5 years of evolution, users of continuous glucose monitoring (CGM) with a coverage ≥ 80% 56 days prior to HbA1c. Logistic regression models were used to identify the factors independently associated with grouped microvascular complications and ocular disease. RESULTS: As per data, 1315 participants were included. Patients were classified into tertiles based on the GMI/HbA1c ratio. High glycators were older than intermediate and low glycators (55.4 vs. 53.4 vs. 50.8 years; p < 0.001), respectively. Differences were also observed among the three groups with regard to average glucose (156.3 vs. 161.8 vs. 166.1 mg/dL; p < 0.001), time in range (66.3% vs. 62.9% vs. 59.9%; p < 0.001), time in tight range (42.9% vs. 39.9% vs. 37.1%; p < 0.001), coefficient of variation (34.5% vs. 34.9% vs. 35.6%; p = 0.023), GMI (7% vs. 7.2% vs. 7.3%; p < 0.001) and HbA1c (8.1% vs. 7.3% vs. 6.6%; p < 0.001). In the high glycators group, the prevalence of microvascular complications was higher than in the intermediate and low glycators (38.9% vs. 28.2% vs. 23.7%; p < 0.001), respectively. Also, the prevalence of ocular disease (31% vs. 20.2% vs. 19.7%; p < 0.001), nephropathy (14.9% vs. 8.3% vs. 6.2%; p < 0.001) and polyneuropathy (10.6% vs. 6.8% vs. 3.4%; p < 0.001) was higher in high glycators, The GMI/HbA1c ratio was significantly associated with the presence of grouped microvascular complications (OR 0.71; 95% CI: 0.61-0.81; p < 0.001) and ocular disease (OR 0.71; 95% CI: 0.61-0.82; p < 0.001) after adjusting for clinical ad glucometric variables. CONCLUSIONS: The GMI/HbA1c ratio is associated with microvascular complications in this study. These results highlight the potential of this parameter in routine clinical practice for stratifying the risk of complications and for establishing individualized control goals and screening strategies.
Source: Diabetes Obesity and Metabolism
DOI: 10.1111/dom.71385
Authors: Sandra Herranz‐Antolín, María Asunción Martínez‐Brocca, Gloria Cánovas‐Molina, Aurora Aragón‐Alonso, Miguel Brito‐Sanfiel, Jose Ignacio Martínez‐Montoro, Virginia Bellido, Sharona Azriel, María del Carmen López‐García, Cristina Tejera, Amparo Bartual, Verónica Perea, Pedro José Pines, Antonio J. Amor, Óscar Moreno‐Pérez, Rebeca Reyes‐García, Gema López‐Gallardo, María Durán‐Martínez, Cristina Serrano, Rosa Márquez‐Pardo, Noemí González‐Pérez de Villar, Manuel Gargallo, Estefanía Santos, Pedro Pujante, Jessica Ares, Diego Bellido, Ignacio Conget, Fernando Gomez‐Peralta
Institutions: Hospital Universitario de Guadalajara, Servicio de Salud de Castilla La Mancha, Hospital Universitario Virgen Macarena, Hospital Universitario de Fuenlabrada, Hospital Universitario Virgen de la Arrixaca, Hospital Universitario Puerta de Hierro Majadahonda, Hospital Clínico Universitario Virgen de la Victoria, Hospital Universitario Virgen del Rocío, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Complejo Hospitalario Universitario de Albacete, Universidade da Coruña, Universidade de Santiago de Compostela, Complexo Hospitalario Universitario A Coruña, Epigenomics (Germany), Universitat de València, Hospital Clínico Universitario de Valencia, Hospital General Universitario De Valencia, University Hospital Mútua de Terrassa, Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas, Hospital Clínic de Barcelona, University of Alicante, Instituto Bernabeu, Hospital General Universitario de Alicante Doctor Balmis, Complejo Hospitalario Torrecárdenas, Hospital Universitario de Getafe, Hospital General De Segovia, Hospital Juan Ramón Jiménez, Hospital Universitario La Paz, Hospital Universitario Fundación Jiménez Díaz, Hospital Universitario de Burgos, Hospital Universitario Central de Asturias
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $5,380
Funder: Abbott Diabetes Care
OpenAlex ID: W7221950885