Background: Glucose management indicator (GMI) value is often used without a paired hemoglobin A1c (A1c) during telehealth encounters. There are known discrepancies between GMI and A1c that have the potential to influence decision-making regarding weaning off insulin in the post-total pancreatectomy with islet auto transplantation (TPIAT) population. Our objective was to compare point-of-care (POC) A1c with 14-day GMI levels, 1-year post-TPIAT, and to consider its impact on insulin management. Methods: We reviewed the medical records of 59 patients who underwent TPIAT surgery at Cincinnati Children’s Hospital 1-year post-TPIAT. Patients who had a POC A1c result and continuous glucose monitoring (CGM) data 12 months post-TPIAT were included in this analysis and were stratified into 2 groups based on POC A1c above or below 6.5%. Results: A total of 33 patients, 1-year post-TPIAT, were included in this study. Median POC A1c was 6% (interquartile range IQR = 5.7 to 6.8), while median 14-day GMI was significantly higher at 6.5% (IQR = 6.2 to 6.8) ( P < .0001). The GMI median was 0.5% (IQR = 0.3 to 0.7) higher in the POC A1c <6.5% group, compared to 0.0% (IQR: −0.2 to 0.1) in the POC A1c ≥6.5% group ( P < .0001). Conclusion: Our data demonstrate a significant discordance between 14-day GMI and POC A1c values, particularly when A1c falls below 6.5%, in patients 1-year post-TPIAT. This threshold is critical for patients post-TPIAT, as an A1c of 6.5% or lower is commonly used to wean insulin therapy. Discordance in GMI at this level, if used independently, may therefore directly impact clinical decision-making regarding insulin management in this population.
London et al. (Mon,) studied this question.