Glycemia Risk Index is Associated With Risk of Albuminuria Among Individuals With Type 1 Diabetes

Background: The glycemia risk index (GRI) is a novel composite continuous glucose monitoring (CGM) metric composed of hypoglycemia and hyperglycemia components and is weighted toward extremes. This study aimed to investigate the association between GRI and the risk of albuminuria in type 1 diabetes. Methods: The 90-day CGM tracings of 330 individuals with type 1 diabetes were included in the analysis. Glycemia risk index was divided into five risk zones (A-E), and hypoglycemia and hyperglycemia components were divided into quintiles. Albuminuria was defined as a spot urine albumin-to-creatinine ratio ≥30 mg/g. Associations of albuminuria with GRI and its hypoglycemia and hyperglycemia components were estimated. Results: Mean GRI and glycated hemoglobin (HbA1c) were 40.9 ± 21.3 and 7.3 ± 1.0%, respectively, and the overall prevalence of albuminuria was 17.6%. Prevalence of albuminuria differed significantly by GRI zone (P =.023). In logistic regression analysis, the adjusted odds ratio (OR) of albuminuria per increase in the GRI zone was 1.70 (95% confidence interval [CI]: 1.19-2.41) after adjusting for various factors affecting albuminuria. The association remained significant after adjusting for achievement of the recommended target of time in range (70-180 mg/dL; >70%) or HbA1c (<7%). The hyperglycemia component of GRI was also associated with albuminuria, and the association remained significant even after adjusting for HbA1c level itself (adjusted OR 1.44, 95% CI: 1.05-1.98). Conclusions: Glycemia risk index is significantly associated with albuminuria in individuals with type 1 diabetes.