Glycemia Risk Index Measures Hypoglycemia, Hyperglycemia Risk in Patients With T1D

The glycemia risk index (GRI) showed that pediatric patients and those receiving continuous subcutaneous insulin infusion had higher overall component of hypoglycemia than adults and those receiving multiple doses of insulin.

The glycemia risk index (GRI) was shown to be a useful glycemic meter that can assess risk of hypoglycemia and hyperglycemia in individuals with type 1 diabetes (T1D), according to a study published in the Journal of Diabetes Science and Technology.

The cross-sectional study included 202 patients with T1D—65 pediatric patients and 137 adults patients—with a mean (SD) age of 28.6 (15.7) years and a mean T1D evolution of 12.5 (10.9) years.

These patients received intensive treatment with insulin and intermittent scanning (flash) glucose monitoring (isCGM). Overall, 51 (25.2%) patients were receiving continuous subcutaneous insulin infusion (CSII), with 30.8% of pediatric patients and 22.6% of adult patients receiving the treatment. The other 151 (74.8%) patients received multiple doses of insulin (MDI).

Researchers collected clinical and glucometric isCGM data including glycated hemoglobin (HbA1c) levels, as well as the component of hypoglycemia (CHypo) and component of hyperglycemia (CHyper) of the GRI.

Adult patients presented higher HbA1c and lower time in range (TIR) values compared with pediatric patients. Mean (SD) HbA1c was 7.4% (1.1) in adults and 6.7% (0.6) in pediatric patients (P < .01). Additionally, TIR was 55.4% (17.5) in adults and 66.5% (13.1) in children (P < .01). Adults with T1D also had a lower coefficient of variation (CV), with a mean of 38.6% (7.2) compared with 42.4% (8.9) (P < .05).

The authors also found that, despite a better control by classical and GRI parameters, pediatric patients and those receiving CSII had higher overall CHypo compared with adults and those receiving MDI, respectively.

When comparing age groups, GRI was significantly lower in pediatric patients than adults, with a mean (SD) GRI of 48.0 (22.2) in the former group and 56.8 (23.4) in the latter group (P < .05). It was also associated with higher CHypo (7.1 [5.1] vs 5.0 [4.5]; P < .01) and lower CHyper (16.8 [9.8] vs 26.5 [15.1]; P < .01) in the pediatric group than in adults.

When comparing CSII and MDI, the authors found that CSII was linked to a nonsignificant trend of a lower GRI, with a mean (SD) GRI of 51 (15.3) compared with 55 (25.4) in the MDI group (P = .162).

Patients with T1D receiving CSII also had higher levels of CHypo (6.5 [4.1] vs 5.4 [5.0]; P < .01) and lower levels of CHyper (19.6 [10.6] vs 24.6 [15.2]; P < .05) compared with patients receiving MDI.

In both cases, according to the authors, these trends show that greater CHypo was linked to a lower final relative weight compared with CHyper, despite being more weighted in the GRI calculation. However, they noted that the difference between the adult and pediatric patients was greater when evaluating TIR, with a difference of 11.1%, than when evaluating GRI, with a difference of 8.8%.

“This lower difference between groups in terms of GRI can be explained by the low sensitivity of TIR to TBR (thus, CHypo) and the higher weight of TBR in GRI calculation,” the authors said. “The analysis of pediatric and adult patients according to the type of treatment supports the latter statement.”


Díaz-Soto G, Pérez-López P, Férnandez-Velasco P, et al. Glycemia risk index assessment in a pediatric and adult patient cohort with type 1 diabetes mellitus. J Diabetes Sci Technol. Published online February 16, 2023 doi:10.1177/19322968231154561

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