Glycemia Risk Index Assessment in a Pediatric and Adult Patient Cohort With Type 1 Diabetes Mellitus

Abstract

Background: To evaluate the glycemia risk index (GRI) as a new glucometry in pediatric and adult populations with type 1 diabetes (T1D) in clinical practice. Methods: A cross-sectional study of 202 patients with T1D receiving intensive treatment with insulin (25.2% continuous subcutaneous insulin infusion [CSII]) and intermittent scanning (flash) glucose monitoring (isCGM). Clinical and glucometric isCGM data were collected, as well as the component of hypoglycemia (CHypo) and component of hyperglycemia (CHyper) of the GRI. Results: A total of 202 patients (53% males and 67.8% adults) with a mean age of 28.6 ± 15.7 years and 12.5 ± 10.9 years of T1D evolution were evaluated. Adult patients (>19 years) presented higher glycated hemoglobin (HbA1c) (7.4 ± 1.1 vs 6.7 ± 0.6%; P < .01) and lower time in range (TIR) (55.4 ± 17.5 vs 66.5 ± 13.1%; P < .01) values than the pediatric population, with lower coefficient of variation (CV) (38.6 ± 7.2 vs 42.4 ± 8.9%; P < .05). The GRI was significantly lower in pediatric patients (48.0 ± 22.2 vs 56.8 ± 23.4; P < .05) 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) than in adults. When analyzing treatment with CSII compared with multiple doses of insulin (MDI), a nonsignificant trend to a lower GRI was observed in CSII (51.0 ± 15.3 vs 55.0 ± 25.4; P= .162), with higher levels of CHypo (6.5 ± 4.1 vs 5.4 ± 5.0; P < .01) and lower CHyper (19.6 ± 10.6 vs 24.6 ± 15.2; P < .05) compared with MDI. Conclusions: In pediatric patients and in those with CSII treatment, despite a better control by classical and GRI parameters, higher overall CHypo was observed than in adults and MDI, respectively. The present study supports the usefulness of the GRI as a new glucometric parameter to evaluate the global risk of hypoglycemia-hyperglycemia in both pediatric and adult patients with T1D.

Evaluation of time in tight range and the glycaemia risk index in adults with type 1 diabetes using an advanced hybrid closed loop system: A 1‐year real‐world assessment

“…10 Of note, the mean TiTR values reported in these studies are greater compared with those measured in our population; as observed for other glycaemic outputs, this difference may be attributable to the distinct ages of the populations included (adults vs. paediatric T1D patients). 38 Regardless of the age category, the current study and previous studies confirmed that automated insulin-delivery systems ameliorated TiTR in T1D patients, further corroborating the achievement of prolonged good glycaemic outcomes.…”

Glycemic variability through the perspective of the glycemia risk index and time in range and their association with glycated hemoglobin A1c in pediatric patients on sensor-augmented pump therapy

“…CV, traditionally regarded as a parameter describing glucose variability ( 23 ), did not exhibit a statistical significance with the laboratory-measured parameters in our study. Introducing the GRI as a new variability parameter is promising for overcoming this limitation ( 24 ). Furthermore, in addition to CV and TIR, the GRI demonstrated a dependence on the total daily insulin dose in our study, indicating its correlation with and dependence on the values derived from all parameters of the ambulatory glucose profile.…”

Quality of life, diabetes-related stress and treatment satisfaction are correlated with glycemia risk index (GRI), time in range and hypoglycemia/hyperglycemia components in type 1 diabetes

“…Recently, the appearance of the Glycemic Risk Index (GRI) [14] as a new parameter to measure the quality of glycemic control in patients with diabetes has demonstrated its usefulness in adult and pediatric patients in clinical practice [15,16]. In addition, GRI has proved its simplicity, ease of calculation and interpretation and its good correlation with the other parameters of the CGM, especially with TIR [17,18].…”