Associations of GA and GMI/GA Ratio With All‐Cause Mortality in Well‐Controlled Type 2 Diabetes Defined by Continuous Glucose Monitoring

AIMS: There is uncertainty whether traditional glycemic metrics remain associated with long-term outcomes among patients with type 2 diabetes who achieve recommended continuous glucose monitoring (CGM) targets. This study was aimed to investigate the association of glycated albumin (GA) and ratio of glucose management indicator to GA (GMI/GA) with risks of all-cause mortality in type 2 diabetes achieving CGM targets. MATERIALS AND METHODS: ) <25%, were included in the cohort study. Cox proportional hazards models and restricted cubic spline were used to evaluate associations of GA and GMI/GA with mortality. RESULTS: During a median follow-up of 11.0 years, 514 patients (14.8%) died. GA exhibited significant linear positive association with risks of all-cause mortality, and the highest GA quartile had 34% increased risk (HR = 1.34, 95% CI 1.01-1.78). Conversely, GMI/GA ratio showed significant non-linear association (p for nonlinearity = 0.042). Compared with the reference third quartile (0.36-0.40), participants in the lowest quartile (<0.30) had 40% higher risk of all-cause mortality (HR = 1.40, 95% CI 1.10-1.80). CONCLUSION: Among patients achieving CGM targets, elevated GA and lower GMI/GA were associated with higher risks of all-cause mortality. These findings suggest that traditional glycemic metrics may complement CGM metrics in the assessment of long-term risks.