Glucose management indicator (GMI) was developed using a linear regression formula to estimate A1C from mean glucose. The study population that was used to develop and validate GMI had a mean A1C of 7.3 ± 0.8%. Therefore, we hypothesize that GMI may overestimate A1C in those with A1C <6.5%. Non-pregnant adults (≥18 years) with T1D for ≥2 years and using Dexcom G6 for ≥6 months from Barbara Davis Center for Diabetes (n=93, 40.6 ± 12.6 years, female 58.4%, A1C 5.9 ± 0.4%) and subjects from “Glucose Sensor Profile in Healthy Non-diabetic Subjects” study (N=153, 31.2± 21.0 years, female 66.0%, A1C 5.1 ± 0.3%) were included. All participants used Dexcom G6 continuous glucose monitor (CGM) . Up to days (healthy participants) and 15 days (T1D patients) of CGM data was compared with laboratory A1C. Discordance in GMI and A1C is presented by A1C <5.7% (healthy participants) and A1C between 5.7-6.4% (T1D patients) . The degree of discordance between GMI and A1C was higher in those with A1C<6.5% compared to original GMI development cohort [Figure 1A]. The differences between A1C and GMI were largely negative in both A1C categories (A1C <5.7% and A1C of 5.7-6.4%) . On average, GMI was 0.59% higher in the A1C < 5.7% group and 0.49% higher in the A1C 5.7 - 6.4% group (both p < 0.0001) [Figure 1B and 1C]. The current GMI formula may overestimate A1C and may need to be re-assessed for those with A1C <6.5%.
V.Shah: Advisory Panel; Medscape, Sanofi, Consultant; Dexcom, Inc., Research Support; Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Novo Nordisk. T.B.Vigers: None. L.Pyle: None. S.Dubose: None. P.Calhoun: None. R.M.Bergenstal: Advisory Panel; Hygieia, Medtronic, Roche Diabetes Care, Zealand Pharma A/S, Consultant; Abbott Diabetes, Ascensia Diabetes Care, Bigfoot Biomedical, Inc., CeQur SA, Dexcom, Inc., Eli Lilly and Company, Novo Nordisk, Onduo LLC, Sanofi, United HealthCare Services, Inc., Research Support; Abbott Diabetes, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Medtronic, Novo Nordisk, Sanofi.