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Multicenter Study
. 2025 Feb 14;24(1):75.
doi: 10.1186/s12933-025-02637-4.

Association between the GMI/HbA1c ratio and preclinical carotid atherosclerosis in type 1 diabetes: impact of the fast-glycator phenotype across age groups

Carlos Puig-Jové  1 , Clara Viñals  2   3 , Ignacio Conget  2   3 , Carmen Quirós  1 , Irene Vinagre  2   3 , Belén Berrocal  1 , Antonio-Jesús Blanco-Carrasco  2   3 , Montserrat Granados  2 , Alex Mesa  2   4 , Tonet Serés-Noriega  2 , Marga Giménez  2   3 , Verónica Perea #  5 , Antonio J Amor #  6   7
Affiliations
Multicenter Study

Association between the GMI/HbA1c ratio and preclinical carotid atherosclerosis in type 1 diabetes: impact of the fast-glycator phenotype across age groups

Carlos Puig-Jové et al. Cardiovasc Diabetol. .

Abstract

Background: Since the arrival of continuous glucose monitoring (CGM), the relationship between the glucose management indicator (GMI) and HbA1c has been a topic of considerable interest in diabetes research. This study aims to explore the association between the GMI/HbA1c ratio and the presence of preclinical carotid atherosclerosis in type 1 diabetes (T1D).

Methods: Individuals with T1D and no prior history of cardiovascular disease were recruited from two centers. Carotid ultrasonography was performed using a standardized protocol and carotid plaques were defined as intima-media thickness ≥ 1.5 mm. CGM-derived data were collected from a 14-day report. A GMI/HbA1c ratio < 0.90 was selected to identify "fast-glycator" phenotype.

Results: A total of 584 participants were included (319 women, 54.6%), with a mean age of 48.8 ± 10.7 years and a mean diabetes duration of 27.5 ± 11.4 years. Carotid plaques were present in 231 subjects (39.6%). Approximately 43.7% and 13.4% of participants showed absolute differences of ≥ 0.5 and ≥ 1.0 between 14-day GMI and HbA1c, respectively. Among patients ≥ 48 years, the fast-glycator phenotype was independently associated with presence of plaques (OR 2.27, 95%CI: 1.06-4.87), even after adjusting for non-specific and T1D-specific risk factors and statin treatment. No significant association was observed in younger subjects (p for interaction < 0.05).

Conclusions: Fast-glycator phenotype is independently associated with atherosclerosis in T1D individuals aged ≥ 48 years, suggesting an age-related increase in the glycation risk. These findings highlight the potential of the GMI/HbA1c ratio for cardiovascular risk stratification in this population.

Keywords: Carotid atherosclerosis; Glucose Management Indicator; Hemoglobin glycation; Type 1 diabetes.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study protocol was conducted according to the principles of the Declaration of Helsinki and approved by hospital Research Ethics Committee (HCB/2017/0977 and HCB/2022/0473). All the participants signed written informed consent forms. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Distribution of patients by difference and absolute difference between GMI and HbA1c values (%). A: The figure illustrates the distribution of patients based on the difference between their 14-day GMI and HbA1c levels. The x-axis represents the difference between GMI and HbA1c. The y-axis shows the percentage of patients in the overall cohort within each difference category. Bars on the left represent patients with HbA1c values greater than GMI (HbA1c > GMI), while bars on the right represent those with GMI values greater than HbA1c (GMI > HbA1c). Patients with the same HbA1c and GMI values have been excluded. B: The graph is a visual representation of the distribution of patients based on the absolute difference between GMI and HbA1c values (%). GMI: Glucose Management Indicator. HbA1c: glycated hemoglobin
Fig. 2
Fig. 2
Probability of plaque presence according to GMI/HbA1c ratio and stratifying for age. Model was adjusted for center, gender, LDL- and HDL-cholesterol, BMI, systolic BP, statin treatment, smoking status, duration of diabetes, type of insulin treatment, CGM system, and the presence of microvascular complications (retinopathy and DKD). Dark line: mean probability; Grey area: 95% confidential interval. BMI: Body Mass Index. BP: Blood Pressure. CGM: Continuous Glucose Monitoring. DKD: Diabetic Kidney Disease. GMI: Glucose Management Indicator. HbA1c: glycated hemoglobin. HDL: High Density Lipoprotein. LDL: Low Density Lipoprotein
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References

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