Diabetes/metabolism research and reviews · 2026
Associations of GA and GMI/GA Ratio With All-Cause Mortality in Well-Controlled Type 2 Diabetes Defined by Continuous Glucose Monitoring.
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Ni Jiaying, Zhang Cheng, Cai Jinghao, Wang Chunfang, Zhu Wei, Wang Yufei, Ma Xiaojing, Lu Jingyi, Xia Tian, Zhou Jian
Аннотация
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: A total of 3482 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. 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.
MATERIALS AND METHODS: A total of 3482 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. 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.