1913-P: Comparison of Improvement in the Glycemia Risk Index with Improvement in Time in Range in Studies Using Continuous Glucose Monitoring

Introduction and Objective: The Glycemia Risk Index (GRI) is a composite metric that describes the quality of glycemia of a fourteen-day continuous glucose monitor tracing. It incorporates both percent time in range (TIR), time out of range weighted according to clinical significance, and glycemic variability (GV). By design, the GRI might be a more sensitive metric for clinical improvement than TIR. Methods: We performed a literature review on Google Scholar and PubMed using the search string (“glycemia risk index” OR “GRI”) AND (“time in range” OR “TIR”) for studies published from 2022 until September 2, 2025. We sought clinical trials and observational population studies that evaluated a therapeutic or behavioral intervention and reported both the GRI and TIR before and after the intervention. We compared individual delta TIRs and delta GRIs for each study as well as the population mean TIR and mean GRI for the 34 studies. We calculated correlation coefficients of TIR with coefficient of variation (CV) and GRI with CV. Results: We investigated 34 studies meeting our search criteria. In every study the magnitude of changes in GRI was larger than the magnitude of changes in TIR. For the group of studies, the mean delta TIR was 12.4% (+/- 8.1% Standard Deviation) and the mean delta GRI was 16.4 percentile (+/- 12.5 percentile) p0.002. The unweighted correlation coefficient was higher between GRI and CV than between TIR and CV, both pre-intervention (p=0.460) and post-intervention (p=0.159). Conclusion: In our literature review of retrospective studies, the magnitude of changes in GRI were larger than those of the changes in TIR. We conclude that in interventions where the TIR improves, then GRI also improves. This is a reason to test the correlation of the GRI with risk stratification of outcomes in prospective interventions. The GRI shows promise as a metric for predicting favorable outcomes to therapy. Disclosure M. Shao: None. A.F. Scheideman: None. A. Ayers: Consultant; Ended; Liom Health AG. V. Shah: Advisory Panel; Current; Abbott Diabetes, Dexcom, Inc. Advisory Panel; Ended; Medtronic. Advisory Panel; Current; Novo Nordisk, Eli Lilly and Company. Consultant; Current; Insulet Corporation, T1D Exchange. Advisory Panel; Current; Sanofi, Tandem Diabetes Care, Inc. Consultant; Ended; DreaMed Diabetes, Ltd. G. Umpierrez: Research Support; Current; Abbott, Dexcom, Inc., Bayer AG. Advisory Panel; Ended; Sanofi-Aventis U.S., Dexcom, Inc. Other - Education grant; Current; Lilly Diabetes, Abbott Diabetes. Advisory Panel; Current; Glycare, Glucotrack. Research Support; Current; Corcept Therapeutics. B. Kovatchev: Research Support; Current; Dexcom, Inc. Other - Patent royalties handled by the UVA Licensing and Ventures Group; Current; Dexcom, Inc. Research Support; Current; Tandem Diabetes Care, Inc. Other - Patent royalties handled by the UVA Licensing and Ventures Group; Current; Tandem Diabetes Care, Inc. Research Support; Ended; Novo Nordisk. Other - Patent royalties handled by the UVA Licensing and Ventures Group; Ended; Novo Nordisk, Sanofi. D. Klonoff: Advisory Panel; Current; Afon Technology, Atropos Health, Embecta, Glooko, Inc., Glucotrack, Lifecare, Inc. Advisory Panel; Ended; Novo Nordisk. Advisory Panel; Current; Sanofi, Synchneuro, Thirdwayv Inc.