Interpreting Glucose Management Indicator and Point-of-Care Hemoglobin A1c Discrepancies in Pediatric Patients with Islet Autotransplantation and Hemoglobin A1c Under 6.5%: A Guide for TPIAT Providers.

Authors

Bella London, Lindsey Hornung, Deborah Elder, Siobhan Tellez

Published in

Journal of diabetes science and technology. Pages 19322968261465344. Jul 20, 2026. Epub Jul 20, 2026.

Abstract

Glucose management indicator (GMI) value is often used without a paired hemoglobin A1c (A1c) during telehealth encounters. There are known discrepancies between GMI and A1c that have the potential to influence decision-making regarding weaning off insulin in the post-total pancreatectomy with islet auto transplantation (TPIAT) population. Our objective was to compare point-of-care (POC) A1c with 14-day GMI levels, 1-year post-TPIAT, and to consider its impact on insulin management.
We reviewed the medical records of 59 patients who underwent TPIAT surgery at Cincinnati Children's Hospital 1-year post-TPIAT. Patients who had a POC A1c result and continuous glucose monitoring (CGM) data 12 months post-TPIAT were included in this analysis and were stratified into 2 groups based on POC A1c above or below 6.5%.
A total of 33 patients, 1-year post-TPIAT, were included in this study. Median POC A1c was 6% (interquartile range [IQR] = 5.7 to 6.8), while median 14-day GMI was significantly higher at 6.5% (IQR = 6.2 to 6.8) (P < .0001). The GMI median was 0.5% (IQR = 0.3 to 0.7) higher in the POC A1c <6.5% group, compared to 0.0% (IQR: -0.2 to 0.1) in the POC A1c ≥6.5% group (P < .0001).
Our data demonstrate a significant discordance between 14-day GMI and POC A1c values, particularly when A1c falls below 6.5%, in patients 1-year post-TPIAT. This threshold is critical for patients post-TPIAT, as an A1c of 6.5% or lower is commonly used to wean insulin therapy. Discordance in GMI at this level, if used independently, may therefore directly impact clinical decision-making regarding insulin management in this population.

PMID:
42473806
Bibliographic data and abstract were imported from PubMed on 20 Jul 2026.

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