# The Usefulness of the Glucose Management Indicator in Evaluating the Quality of Glycemic Control in Patients with Type 1 Diabetes Using Continuous Glucose Monitoring Sensors: A Cross-Sectional, Multicenter Study

## TL;DR

This study evaluates how well the Glucose Management Indicator (GMI) estimates blood sugar control in type 1 diabetes patients using continuous glucose monitoring sensors.

## Contribution

The study provides empirical validation of GMI's reliability and identifies biases in its estimates based on HbA1c levels.

## Key findings

- GMI overestimates HbA1c by 0.1 percentage points on average.
- GMI reliability is supported by high inter-item correlation and covariance.
- GMI underestimates high HbA1c and overestimates low HbA1c values.

## Abstract

The Glucose Management Indicator (GMI) is a biomarker of glycemic control which estimates hemoglobin A1c (HbA1c) based on the average glycemia recorded by continuous glucose monitoring sensors (CGMS). The GMI provides an immediate overview of the patient’s glycemic control, but it might be biased by the patient’s sensor wear adherence or by the sensor’s reading errors. This study aims to evaluate the GMI’s performance in the assessment of glycemic control and to identify the factors leading to erroneous estimates. In this study, 147 patients with type 1 diabetes, users of CGMS, were enrolled. Their GMI was extracted from the sensor’s report and HbA1c measured at certified laboratories. The median GMI value overestimated the HbA1c by 0.1 percentage points (p = 0.007). The measurements had good reliability, demonstrated by a Cronbach’s alpha index of 0.74, an inter-item correlation coefficient of 0.683 and an inter-item covariance between HbA1c and GMI of 0.813. The HbA1c and the difference between GMI and HbA1c were reversely associated (Spearman’s r = −0.707; p < 0.001). The GMI is a reliable tool in evaluating glycemic control in patients with diabetes. It tends to underestimate the HbA1c in patients with high HbA1c values, while it tends to overestimate the HbA1c in patients with low HbA1c.