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

Authors

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

Published in

Diabetes, obesity & metabolism. Oct 15, 2026. Epub Oct 15, 2026.

Abstract

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).
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.
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.
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.

PMID:
42881122
Bibliographic data and abstract were imported from PubMed on 16 Oct 2026.

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