Background Continuous glucose monitoring (CGM) has significantly improved glycaemic management in individuals with diabetes. The Glycaemia Risk Index (GRI) is a composite metric based on CGM data that provides a comprehensive evaluation of glycaemic quality, incorporating both hypoglycaemia and hyperglycaemia. This study evaluated the impact of transitioning from self-monitoring of blood glucose (SMBG) to CGM on GRI in adults with type 1 diabetes (T1D) using multiple daily injection (MDI) insulin therapy. Methods Secondary analyses were conducted in 125 adults with T1D from the randomised GOLD trial. Participants alternated between CGM and SMBG for two 26-week periods, separated by a 17-week wash-out. The GRI was calculated on a 0–100 scale from CGM data and categorised into five risk zones. Associations between baseline characteristics and participant-reported outcomes such as diabetes-related behaviours, lifestyle, psychological characteristics, and changes in GRI were also explored. Results Transitioning from SMBG to CGM significantly reduced the overall GRI by 9.8 units (95% CI −13.3, −6.3), with decreases in both hypoglycaemia (–1.8, 95% CI −2.4, −1.2) and hyperglycaemia (–2.8, 95% CI −5.3, −0.4) components. GRI zone classification was maintained or improved in 85.4% (105/123, P .001) of participants. The GRI correlated moderately with TIR ( r = –0.47, 95% CI −0.60, −0.32), but standardised effect sizes were larger for GRI than for TIR (–0.5 95% CI –0.72, –0.34 vs. 0.2 95% CI 0.00, 0.37). Exploratory analyses suggested that self-reported psychosocial traits influenced GRI changes: thoroughness was linked to greater reductions in hypoglycaemia risk, whereas distractibility, self-described laziness, and carbohydrate counting training were associated with smaller improvements. Conclusion Switching from SMBG to CGM significantly improved GRI in adults with T1D on MDI therapy. Compared with TIR, GRI demonstrated greater responsiveness to treatment-related changes. As a composite metric that integrates both hypo- and hyperglycaemia, GRI may serve as a valuable endpoint for evaluating interventions and as a complementary measure in clinical practice.
Pylov et al. (Wed,) studied this question.