Trends in Glycemia Risk Index Over Time in Patients With Diabetes and Cancer Undergoing Remote Continuous Glucose Monitoring

Background: Continuous glucose monitoring (CGM) is increasingly used in patients with cancer, a population in whom HbA1c may be unreliable. The Glycemia Risk Index (GRI) is a CGM-derived measure integrating hypoglycemia and hyperglycemia risk. We evaluated trends in GRI and other CGM metrics among adults followed in a remote CGM (RCGM) clinic. Methods: Retrospective chart review of adults (≥18 years) with diabetes and cancer seen at a comprehensive cancer center in 2024. Eligible patients had ≥2 CGM assessments (≥1 RCGM) and a baseline glucose management indicator (GMI) or HbA1c ≥8.0%. Generalized linear mixed models examined the effects of visit sequence (time) and RCGM use on GRI, GMI, average glucose, time in range (TIR), time above range (TAR), and time below range (TBR). Pre-specified conservative and liberal noninferiority margins were applied to the remote-use effect. Results: Forty-two patients (mean age 60.2 ± 10.6 years; 95% type 2 diabetes) were included. At baseline, mean GRI was 70 ± 27, GMI 8.5% ± 1.1%, average glucose 214 ± 46 mg/dL, TIR 38% ± 21%, TAR 61% ± 21%, and TBR 1% ± 1%. Across sequential assessments, GRI, GMI, average glucose, and TAR decreased, whereas TIR increased (all P < .05). Remote CGM did not predict any glycemic outcome. Under liberal margins, RCGM was noninferior to nonremote review for GRI, GMI, TIR, and TAR, and noninferior for TBR under both conservative and liberal margins. Conclusions: Sequential CGM review was associated with improved glycemic quality in adults with diabetes and cancer. Remote CGM achieved glycemic outcomes comparable with nonremote review, supporting its use as a viable adjunct to in-person visits in the oncology setting.