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June 7, 2026Diabetes

Higher CGM-derived GMI is linked to ~34% greater serious CVD risk but lacks independence from HbA1c.

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Why the study?

Whether continuous glucose monitoring (CGM) metrics predict long-term cardiovascular disease and mortality outcomes beyond HbA1c in type 2 diabetes remains unclear.

Do CGM metrics (TIR and GMI) predict serious CVD and mortality beyond HbA1c in patients with type 2 diabetes?

Population

1,363 participants with 10-day CGM in the GRADE study

Comparison

CGM-derived TIR and GMI vs HbA1c

Design

Substudy of a comparative effectiveness study

Follow-up

Median 2.3 years

Key result

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.

Authors

MTMENGYAO TANGDNDAVID M. NATHANDWDEBORAH WEXLER

Discussion

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Member takes

Overview

GMI does not add independent prognostic value beyond HbA1c for CVD in T2D; leaves open whether CGM metrics improve risk stratification in prospective studies.

Key Points

  • This study investigates whether CGM metrics can predict cardiovascular disease and mortality outcomes beyond HbA1c in individuals with type 2 diabetes.
  • Analyzed data from 1,363 participants in the GRADE study with 10-day CGM data.
  • Outcomes included serious cardiovascular events and all-cause mortality.
  • Cox models estimated hazard ratios for TIR and GMI with HbA1c as a comparator.
  • Higher GMI predicted serious cardiovascular events (HR 1.34 [1.09-1.65]) and mortality (HR 1.36 [1.02-1.83]).
  • Higher HbA1c also predicted cardiovascular events (HR 1.30 [1.06-1.59]) and mortality (HR 1.42 [1.04-1.94]).
  • Higher TIR was protective for cardiovascular disease (HR 0.78 [0.62-0.98]) but not associated with death.

Study Design

Type

Cohort (n=1,363)

Structured PICO

Do CGM metrics (TIR and GMI) predict serious CVD and mortality beyond HbA1c in patients with type 2 diabetes?

P
Population
1,363 participants with type 2 diabetes and 10-day CGM data from the GRADE study, followed for a median of 2.3 years.
E
Exposure
CGM-derived time in range (TIR) and glucose management indicator (GMI)
C
Comparator
HbA1c
O
Outcome
Serious CVD (MACE, heart failure hospitalization, angina, revascularization) and all-cause mortalitycomposite

Main Result

Hazard Ratio: 1.34 (95% CI 1.09–1.65)

CGM-derived GMI and HbA1c comparably predict cardiovascular and mortality outcomes in type 2 diabetes, but their prognostic values overlap and are not additive.

Cite This Study

TANG et al. (2026) 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.

synapsesocial.com/papers/6a250ce97def13d035e1d134https://doi.org/10.2337/db26-2962-lb
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