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Use of the Glycemia Risk Index at Hybrid Closed-Loop Initiation to Predict Combined International Glucose Targets at

Sylvie Picard1, Joëlle Dupont2, Fabienne Amiot-Chapoutot3

  • 1Endocrinology and Diabetes, Point Medical, Dijon, France.

Journal of Diabetes Science and Technology
|October 5, 2025
PubMed

Insights

The glycemia risk index (GRI) at hybrid closed-loop (HCL) therapy initiation predicts achieving glucose targets in persons with type 1 diabetes (PwT1D). Lower initial GRI values strongly indicate successful outcomes, while higher values require closer monitoring.

Area of Science:

  • Endocrinology
  • Metabolic Diseases
  • Biomedical Engineering

Background:

  • Hybrid closed-loop (HCL) therapy is crucial for managing type 1 diabetes (T1D).
  • Efficacy and safety glucose targets (ESGT+) are key performance indicators for HCL therapy.
  • The glycemia risk index (GRI) is a metric used to assess glucose control.

Purpose of the Study:

  • To analyze the glycemia risk index (GRI) in persons with type 1 diabetes (PwT1D) at HCL initiation (M0) and 12 months (M12).
  • To determine if M0 GRI values and/or zones can predict reaching M12 ESGT+.

Main Methods:

  • Retrospective study of PwT1D initiating HCL therapy.
  • Manual extraction of glucose parameters at M0 and M12.
  • Calculation of GRI and receiver-operating characteristic (ROC) analyses to assess prediction accuracy.

Main Results:

  • M0 GRI predicted M12 ESGT+ outcomes, particularly at low (<41) and high (≥61) values.
  • An M0 GRI < 41 showed 90% specificity for M12 ESGT+.
  • All individuals in M0 GRI zone A (0-20) achieved M12 ESGT+; outcomes decreased progressively through zones B-E.

Conclusions:

  • M0 GRI is significantly associated with M12 ESGT+ status, especially in zones A-B and D-E.
  • PwT1D with M0 GRI ≥ 41 require focused HCL training, as they represent 90% of those not reaching ESGT+.
  • Achieving M12 ESGT+ is possible even with M0 GRI in zones C-E, highlighting the need for tailored HCL therapy adjustments.
Abstract

Keywords:
glucose targetsglycemia risk index (GRI)hybrid closed looptype 1 diabetes

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