Association Between the GMI / HbA1c Ratio and Microvascular Complications in Type 1 Diabetes: A Multicenter Cross‐Sectional Study

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.

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Journal
Diabetes Obesity and Metabolism
Published
2026-10-15
DOI
https://doi.org/10.1111/dom.71385
Primary Topic
Diabetes Management and Research
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article

Association Between the GMI / HbA1c Ratio and Microvascular Complications in Type 1 Diabetes: A Multicenter Cross‐Sectional Study

Sandra Herranz-Antolín, Virginia Bellido, Verónica Perea, Rebeca Reyes‐García et al.
Diabetes Obesity and Metabolism
Diabetes Management and Research
article

Association Between the GMI / HbA1c Ratio and Microvascular Complications in Type 1 Diabetes: A Multicenter Cross‐Sectional Study

Sandra Herranz-Antolín, Virginia Bellido, Verónica Perea, Rebeca Reyes‐García, José Ignacio Martínez‐Montoro, Jessica Ares, Gema López-Gallardo, Miguel Ángel Brito-Sanfiel, Maria Asunción Martínez‐Brocca, Marı́a Durán-Martinez, Sharona Azriel, Fernando Gómez‐Peralta, Pedro Pujante, Cristina Tejera Pérez, Óscar Moreno, Manuel Gargallo, Ignacio Conget, Antonio Jesús Amor, Rosa Márquez‐Pardo, María Carmen López-García, Estefanía Santos, Pedro José Pinés, Cristina Serrano, Aurora Aragón‐Alonso, Amparo Bartual, Noemí González‐Pérez de Villar, Diego Bellido, Gloria Cánovas‐Molina
article en

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.

Diabetes Obesity and Metabolism
Universidade da Coruña (ES), University of Alicante (ES), Universitat de València (ES), Universidade de Santiago de Compostela (ES), Hospital Universitario La Paz (ES), Instituto de Salud Carlos III (ES), Hospital General De Segovia (ES), Hospital Universitario Virgen Macarena (ES), Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas (ES), Hospital Universitario de Guadalajara (ES), Hospital Clínico Universitario de Valencia (ES), University Hospital Mútua de Terrassa (ES), Hospital Universitario de Getafe (ES), Hospital Universitario Puerta de Hierro Majadahonda (ES), Hospital Clínic de Barcelona (ES), Hospital Universitario de Burgos (ES), Instituto Bernabeu (ES), Hospital General Universitario De Valencia (ES), Hospital Juan Ramón Jiménez (ES), Hospital Universitario Fundación Jiménez Díaz (ES), Hospital Universitario Central de Asturias (ES), Hospital General Universitario de Alicante Doctor Balmis (ES), Complexo Hospitalario Universitario A Coruña (ES), Servicio de Salud de Castilla La Mancha (ES), Hospital Universitario de Fuenlabrada (ES), Hospital Universitario Virgen de la Arrixaca (ES), Complejo Hospitalario Torrecárdenas (ES), Hospital Universitario Virgen del Rocío (ES), Complejo Hospitalario Universitario de Albacete (ES), Hospital Clínico Universitario Virgen de la Victoria (ES), Hospital Universitario Infanta Sofía (ES), Epigenomics (Germany) (DE), Universidad Europea de Madrid (ES)
Abbott Diabetes Care
Good health and well-being
Openalex Percentile: Top 12%
Diabetes Management and Research
DOIOpen Access PDFOpenAlex
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