Journal Article

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

Mesa, Alex, Vinagre, Irene, Amor, Antonio J., Quirós, Carmen, Blanco-Carrasco, Antonio-Jesús, Serés-Noriega, Tonet, Puig-Jové, Carlos, Berrocal, Belén, Perea, Verónica, Conget, Ignacio, Viñals, Clara, Granados, Montserrat, Giménez, Marga

2025

Overview

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. Graphical abstract

• Publisher: BioMed Central,Springer Nature B.V,BMC
• Subject: Adult / Age / Age Factors / Aged / Angiology / Antihypertensives / Arteriosclerosis / Asymptomatic Diseases / Atherosclerosis / Biochemistry / Biomarkers - blood / Blood Glucose - drug effects / Blood Glucose - metabolism / Blood Glucose Self-Monitoring / Blood pressure / Body mass index / Cardiology / Cardiovascular disease / Cardiovascular diseases / Carotid Artery Diseases - blood / Carotid Artery Diseases - diagnostic imaging / Carotid Artery Diseases - epidemiology / Carotid Artery Diseases - etiology / Carotid atherosclerosis / Carotid Intima-Media Thickness / Cholesterol / Creatinine / Cross-Sectional Studies / Diabetes / Diabetes mellitus (insulin dependent) / Diabetes Mellitus, Type 1 - blood / Diabetes Mellitus, Type 1 - diagnosis / Diabetes Mellitus, Type 1 - drug therapy / Diabetes Mellitus, Type 1 - epidemiology / Female / Genotype & phenotype / Glucose Management Indicator / Glucose monitoring / Glycated Hemoglobin - metabolism / Glycemic Control / Glycosylation / Hemoglobin / Hemoglobin glycation / High density lipoprotein / Humans / Hypertension / Hypoglycemia / Hypoglycemic Agents - therapeutic use / Insulin / Laboratories / Male / Medicine / Medicine & Public Health / Middle Aged / Phenotype / Phenotypes / Plaque, Atherosclerotic / Plaques / Predictive Value of Tests / Risk Assessment / Risk Factors / Time Factors / Type 1 diabetes / Ultrasonic imaging / Variables