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Associations of GA and GMI/GA Ratio With All-Cause Mortality in Well-Controlled Type 2 Diabetes Defined by Continuous
Jiaying Ni1, Cheng Zhang2, Jinghao Cai1
1Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China.
Aims:
There is uncertainty whether traditional glycemic metrics remain associated with long-term outcomes among patients with type 2 diabetes who achieve recommended continuous glucose monitoring (CGM) targets. This study was aimed to investigate the association of glycated albumin (GA) and ratio of glucose management indicator to GA (GMI/GA) with risks of all-cause mortality in type 2 diabetes achieving CGM targets.
Materials And Methods:
A total of 3482 patients with type 2 diabetes who met CGM targets, defined as time in range (TIR) >70%, time below range (TBR<3.9) <4%, and time above range (TAR>10.0) <25%, were included in the cohort study. Cox proportional hazards models and restricted cubic spline were used to evaluate associations of GA and GMI/GA with mortality.
Results:
During a median follow-up of 11.0 years, 514 patients (14.8%) died. GA exhibited significant linear positive association with risks of all-cause mortality, and the highest GA quartile had 34% increased risk (HR = 1.34, 95% CI 1.01-1.78). Conversely, GMI/GA ratio showed significant non-linear association (p for nonlinearity = 0.042). Compared with the reference third quartile (0.36-0.40), participants in the lowest quartile (<0.30) had 40% higher risk of all-cause mortality (HR = 1.40, 95% CI 1.10-1.80).
Conclusion:
Among patients achieving CGM targets, elevated GA and lower GMI/GA were associated with higher risks of all-cause mortality. These findings suggest that traditional glycemic metrics may complement CGM metrics in the assessment of long-term risks.
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