Comparison of Glycemia Risk Index with Time in Range for Assessing Glycemic Quality.

The glycemia risk index (GRI) is a novel composite continuous glucose monitoring (CGM) metric that gives greater weight to hypoglycemia than to hyperglycemia and to extreme hypo/hyperglycemia over less extreme hypo/hyperglycemia. This study aimed at validating the effectiveness of GRI and at comparing it with time in range (TIR) in assessing glycemic quality in clinical practice. A total of 524 ninety-day CGM tracings of 194 insulin-treated adults with diabetes were included in the analysis. GRI was assessed according to standard metrics in ambulatory glucose profiles. Both cross-sectional and longitudinal analyses were performed to compare the GRI and TIR. The GRI was strongly correlated not only with TIR ( = -0.974), but also with the coefficient of variation ( = 0.683). To identify whether the GRI differed by hypoglycemia even with a similar TIR, CGM tracings were grouped according to TIR (50% to <60%, 60% to <70%, 70% to <80%, and ≥80%). In each TIR group, the GRI increased as time below range (TBR) increased ( < 0.001 for all TIR groups). In longitudinal analysis, as TBR improved, the GRI improved significantly ( = 0.003) whereas TIR did not ( = 0.704). Both GRI and TIR improved as time above range (TAR) improved ( < 0.001 for both). The longitudinal change was easily identifiable on a GRI grid. The GRI is a useful tool for assessing glycemic quality in clinical practice and reflects hypoglycemia better than does TIR.