1954-P: Impact of GA and GMI/GA Ratio on Risk of All-Cause Mortality in Well-Controlled Type 2 Diabetes Defined by Continuous Glucose Monitoring

Introduction and Objective: To investigate the associations of glycated albumin (GA) and ratio of glucose management indicator to GA (GMI/GA) with all-cause mortality risk in type 2 diabetes achieving continuous glucose monitoring (CGM) targets. Methods: A total of 3,482 patients with type 2 diabetes who met CGM targets, defined as time in range (TIR) > 70%, time below range (TBR< 3.9) < 4%, and time above range (TAR> 10.0) < 25%, were included in the cohort study. Participants were categorized into quartiles of GA or GMI/GA ratio. Cox proportional hazards models and restricted cubic spline analysis were used to examine the associations of GA and GA/GMI ratio with all-cause mortality. Results: During a median follow-up of 11.0 years, 514 patients (14.8%) died. GA exhibited significant linear positive association with all-cause mortality, and the risk of all-cause mortality was 37% higher (95% CI 1.03-1.82) in the highest versus the lowest GA quartile. Conversely, GMI/GA ratio demonstrated significant non-linear association (P for nonlinearity = 0.008). Compared with the reference third quartile (0.36-0.40), participants in the lowest quartile (<0.30) had 47% higher risk of all-cause mortality (95% CI 1.15-1.88). In contrast, CGM metrics (time in tight range, TAR> 10.0, and TIR) showed no significant association with mortality risk (all P for trend > 0.05). Conclusion: Among patients achieving CGM targets, elevated GA and low GMI/GA ratio remained significant predictors of all-cause mortality, with the latter captures the discrepancy between estimated mean glucose and actual biological glycation. These findings suggest that combining traditional glycemic markers with CGM metrics may provide more comprehensive evaluation of glycemic control. Disclosure J. Cai: None. J. Ni: None. W. Zhu: None. Y. Wang: None. J. Lu: None. J. Zhou: None. Funding Noncommunicable Chronic Diseases-National Science and Technology Major Project (2024ZD0532000, 2024ZD0532001), Shanghai Leading Talent Program of Eastern Talent Plan (LJ2024121), and Shanghai Oriental Talent Program (Outstanding Project)