Differences Between Glycated Hemoglobin and Glucose Management Indicator in Real-Time and Intermittent Scanning Continuous Glucose Monitoring in Adults With Type 1 Diabetes

Background: This study demonstrates the difference between glucose management indicator (GMI) and glycated hemoglobin (HbA_1c) according to sensor mean glucose and HbA_1cstatus using 2 continuous glucose monitoring (CGM) sensors in people with type 1 diabetes. Methods: A total of 275 subjects (117 Dexcom G6 [G6] and 158 FreeStyle Libre 1 [FL]) with type 1 diabetes was included. The G6 and FL sensors were used, respectively, over 90 days to analyze 682 and 515 glycemic profiles that coincide with HbA_1c. Results: The mean HbA_1cwas 6.6% in Dexcom G6 and 7.2% in FL profiles. In G6 profiles, GMI was significantly higher than HbA_1cirrespective of mean glucose (all P < .001, mean difference: 0.58% ± 0.49%). The GMI was significantly higher than the given HbA_1cwhen HbA_1cwas below 8.0% (all P < .001). The discordance was the highest at 0.9% for lower HbA_1cvalues (5.0%-5.9%). The proportion of discordance >0.5% improved from 60.1% to 30.9% when using the revised GMI equation in G6 profiles. In FL profile, the overall mean difference between GMI and HbA_1cwas 0 (P = .966). The GMI was significantly lower by 0.9% than HbA_1cof 9.0% to 9.9% and higher by 0.5% in HbA_1cof 5.0% to 5.9% (all P < .001). Conclusions: The GMI is overestimated in G6 users, particularly those with well-controlled diabetes, but the GMI and HbA_1cdiscordance improved with a revised equation from the observed data. The FL profile showed greater discordance for lower HbA_1clevels or higher HbA_1clevels.