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<p>The discordance between glycated haemoglobin (HbA1c) and the glucose management indicator (GMI) has been proposed as a marker of vascular risk in diabetes. This study evaluated whether the GMI/ HbA1c ratio independently predicts diabetic retinopathy (DR) in adults with type 1 diabetes (T1D) using continuous glucose monitoring. We conducted a multicenter cross-sectional study involving 1,070 adults using flash glucose monitoring. Participants were stratified as high glycators (ratio &lt; 0.9) or non-high glycators based on the GMI/HbA1c ratio. DR status was assessed by ophthalmologic evaluation. Multivariable logistic regression and 1:1 propensity score matching were used to assess independent associations with DR, adjusting for age, sex, diabetes duration, smoking, hypertension, LDL cholesterol, BMI and insulin dose. While high glycators had a higher crude DR prevalence (31.3% vs. 23.1%, <i>p</i> = 0.020), the GMI/HbA1c ratio was not independently associated with DR in adjusted models (OR 1.19; 95% CI: 0.34–4.15; <i>p</i> = 0.785) or in the matched cohort (OR 1.23; 95% CI: 0.76–1.99; <i>p</i> = 0.391). Absolute HbA1c remained the strongest glycemic predictor. These findings suggest that the GMI/HbA1c ratio may aid in interpreting discordant glycemic profiles, serving as a contextual tool in clinical practice, but it lacks independent prognostic value for DR.</p>

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The GMI/HbA1c ratio does not independently predict diabetic retinopathy in adults with Type 1 Diabetes

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月14日

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  • Carolina Sager-La Ganga,
  • Jose Alfonso Arranz-Martin,
  • Jessica Jiménez-Díaz,
  • Iñigo Hernando-Alday,
  • Victor Navas-Moreno,
  • Maria del Mar Fandiño García,
  • Gisela Liz Román Gómez,
  • Jon Garai Hierro,
  • Luis Eduardo Lander Lobariñas,
  • Purificación Martinez de Icaya,
  • Miguel Antonio Sampedro-Nuñez,
  • Mónica Marazuela Azpiroz,
  • Fernando Sebastian-Valles

摘要

The discordance between glycated haemoglobin (HbA1c) and the glucose management indicator (GMI) has been proposed as a marker of vascular risk in diabetes. This study evaluated whether the GMI/ HbA1c ratio independently predicts diabetic retinopathy (DR) in adults with type 1 diabetes (T1D) using continuous glucose monitoring. We conducted a multicenter cross-sectional study involving 1,070 adults using flash glucose monitoring. Participants were stratified as high glycators (ratio < 0.9) or non-high glycators based on the GMI/HbA1c ratio. DR status was assessed by ophthalmologic evaluation. Multivariable logistic regression and 1:1 propensity score matching were used to assess independent associations with DR, adjusting for age, sex, diabetes duration, smoking, hypertension, LDL cholesterol, BMI and insulin dose. While high glycators had a higher crude DR prevalence (31.3% vs. 23.1%, p = 0.020), the GMI/HbA1c ratio was not independently associated with DR in adjusted models (OR 1.19; 95% CI: 0.34–4.15; p = 0.785) or in the matched cohort (OR 1.23; 95% CI: 0.76–1.99; p = 0.391). Absolute HbA1c remained the strongest glycemic predictor. These findings suggest that the GMI/HbA1c ratio may aid in interpreting discordant glycemic profiles, serving as a contextual tool in clinical practice, but it lacks independent prognostic value for DR.