Glycemia risk index in pediatric type 1 diabetes: A retrospective observational study of a novel metric for assessing glycemic control and variability.

BACKGROUND: Continuous glucose monitoring (CGM) provides detailed insights into glycemic patterns in type 1 diabetes (T1D), yet clinical interpretation remains complex because of multiple interdependent metrics. The Glycemia Risk Index (GRI) has been proposed as a novel composite metric integrating hyperglycemia and hypoglycemia risk. However, limited data exist on its application in pediatric T1D. This study evaluates the GRI’s correlation with standard CGM metrics and HbA1c in children and adolescents with T1D. METHODS: This retrospective observational study analyzed 307 ambulatory glucose profile (AGP) reports from pediatric patients (≤ 18 years) with T1D using CGM. Key glycemic metrics, including Time in Range (TIR), Time Below Range (TBR), Time Above Range (TAR), Glycemic Management Indicator (GMI), and Coefficient of Variation (CV), were extracted. GRI was calculated using a standard formula and compared across different TIR and HbA1c categories. Correlations between GRI and CGM metrics were assessed using Spearman’s rank correlation, with statistical significance set at p < 0.05. RESULTS: Among 173 participants (mean age 10.1 ± 4.0 years, 50.5% male), median diabetes duration was 23.0 months (IQR: 14.5–41.5). Median TIR 57.0% (42.0–69.0%) with median GRI 57.6 (IQR: 35.2–78.0). GRI demonstrated a strong negative correlation with TIR (ρ = -0.969, p < 0.001), strong positive correlations with TAR (ρ = 0.919, p < 0.001) and CV (ρ = 0.879, p < 0.001), and a moderate positive correlation with HbA1c (ρ = 0.482). CONCLUSION: GRI correlates strongly with CGM-derived glycemic variability and hyperglycemia exposure in pediatric T1D. Its ability to integrate both hypo- and hyperglycemia into a single metric suggests it’s a useful adjunct to HbA1c and TIR in clinical decision-making.