Higher CGM-derived glucose management indicator predicted serious cardiovascular disease (HR 1.34; 95% CI 1.09-1.65), but its prognostic value was not independent of HbA1c.
Cohort (n=1,363)
Do CGM metrics (TIR and GMI) predict serious CVD and mortality beyond HbA1c in patients with type 2 diabetes?
CGM-derived GMI and HbA1c comparably predict cardiovascular and mortality outcomes in type 2 diabetes, but their prognostic values overlap and are not additive.
Hazard Ratio: 1.34 (95% CI 1.09–1.65)
Introduction and Objective: Whether CGM metrics predict long-term cardiovascular disease (CVD) and mortality outcomes beyond HbA1c in type 2 diabetes is unclear. We examined the prognostic value of CGM-derived time in range (TIR) and glucose management indicator (GMI) vs. HbA1c for serious CVD and all-cause death. Methods: We studied 1,363 participants with 10-day CGM in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness (GRADE) study. Outcomes include serious CVD (MACE, heart failure hospitalization, angina, revascularization) and all-cause mortality. Cox models estimated hazard ratios (HR) for TIR and GMI (per 1-SD), with HbA1c as comparator. Model 1 adjusted for age, sex, race/ethnicity, treatment, and diabetes duration. Model 2 mutually adjusted a CGM metric and HbA1c. Results: Over median 2.3 years, 59 CVD events and 26 deaths occurred. In Model 1, higher GMI predicted serious CVD (HR 1.34 1.09-1.65) and death (HR 1.36 1.02-1.83); higher HbA1c similarly predicted CVD (HR 1.30 1.06-1.59) and death (HR 1.42 1.04-1.94). Higher TIR was protective for CVD (HR 0.78 0.62-0.98) but not death. In Model 2, all significant associations were attenuated after mutual adjustment (Figure). Conclusion: GMI and HbA1c comparably predicted CVD and mortality but with overlapping rather than additive prognostic value. TIR was protective for CVD but not independent of HbA1c nor associated with mortality. Disclosure M. Tang: Research Support; Ended; Dexcom, Inc., American Heart Association. D.M. Nathan: Advisory Panel; Ended; Lexicon Pharmaceuticals, Inc. D. Wexler: Other - Data Monitoring Committee; Ended; Novo Nordisk. Other - Data Monitoring Committee; Current; Amgen Inc. M.S. Putman: Advisory Panel; Current; Vertex Pharmaceuticals Incorporated. Research Support; Ended; Vertex Pharmaceuticals Incorporated, Dexcom, Inc. Advisory Panel; Ended; Sanofi. Board Member; Current; Anagram Therapeutics. Research Support; Ended; Samsung. I. de Boer: Consultant; Current; Boehringer Ingelheim International GmbH, Novo Nordisk, GlaxoSmithKline plc., Lilly. Consultant; Ended; Dexcom, Inc. Research Support; Current; Novo Nordisk, Dexcom, Inc. Consultant; Ended; AstraZeneca. Consultant; Current; Roche Diabetes Care. Consultant; Ended; Lexicon Pharmaceuticals, Inc. S. Kalim: None.
TANG et al. (Fri,) conducted a cohort in type 2 diabetes (n=1,363). Glucose management indicator (GMI) and time in range (TIR) vs. HbA1c was evaluated on serious CVD (MACE, heart failure hospitalization, angina, revascularization) (HR 1.34, 95% CI 1.09-1.65). Higher CGM-derived glucose management indicator predicted serious cardiovascular disease (HR 1.34; 95% CI 1.09-1.65), but its prognostic value was not independent of HbA1c.
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