Clinical Value of HbA1c/updatedGMI Ratio in Identifying Early Retinopathy Risk in Type 1 Diabetes

Lurquin, Fabian;Petit, Elise L;Oriot, Philippe;Ahn, Sylvie;Hermans, Michel
(2026) Journal of diabetes science and technology — p. 1-12 (2026)

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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/updatedGMI 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/updatedGMI 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/updatedGMI 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 updatedGMI discrepancy in cardiometabolic risk assessment, but cutoffs remain to be set.
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Lurquin, F., Petit, E. L., Oriot, P., Ahn, S., & Hermans, M. (2026). Clinical Value of HbA1c/updatedGMI Ratio in Identifying Early Retinopathy Risk in Type 1 Diabetes. Journal of diabetes science and technology, 1-12. https://doi.org/10.1177/19322968261426305 (Original work published 2026)