Higher Glycemia Risk Index Associated with Increased Diabetic Retinopathy Risk

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According to new data presented at ADA 2023, patients with T2D experience an increased risk of incident retinopathy per 1-SD increase in glycemia risk index.

A higher glycemia risk index was associated with an increased risk of incident diabetic retinopathy in patients with type 2 diabetes (T2D), according to new research.1

The findings, presented at the 83rd American Diabetes Association Scientific Sessions (ADA 2023), showed the predictive value of the glycemia risk index was comparable to time-in-range.

“The potential value of the glycemia risk index needs to be explored in future studies,” wrote the investigative team, led by Yaxin Wang, from Guangdong Eye Institute in the department of ophthalmology at Guangdong Provincial People’s Hospital.

The glycemia risk index is a new composite metric for assessing the quality of glycemia based on expert ranking by 330 clinicians of 14-day continuous glucose monitoring (CGM) tracings. Compared with the time-in-range, investigators noted the glycemia risk index has been shown to closely correlate with the opinions of clinicians as to the overall quality of glycemic profiles.2

However, Wang and colleagues noted the relationship between the glycemia risk index and diabetes-related outcomes is unknown.2 In the current analysis, the investigative team aimed to investigate the association between glycemia risk index and incident diabetic retinopathy. The analysis included a total of 1,204 adults with type 2 diabetes without diabetic retinopathy at baseline between 2005 - 2019 from a single center in Shanghai, China.

The team obtained a glycemia risk index from 3-day CGM data at baseline. They used Cox proportional hazards regression models to estimate the association between glycemia risk index and incident diabetic retinopathy. Through a median follow-up of 8.4 years, a total of 301 patients developed diabetic retinopathy.

Multivariable-adjusted hazard ratios (HRs) were adjusted for age, sex, current smoking status, diabetes duration, body mass index (BMI), systolic blood pressure, triglycerides, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C). The HRs were measured for incident diabetic retinopathy across ascending glycemia risk index quartiles (≤14 [reference], 15 - 28, 29 - 47, and >47).

Upon analysis, data showed the HRs for incident diabetic retinopathy were 1.00, 1.05 (95% CI, 0.74 - 1.48), 1.33 (95% CI, 0.96 - 1.84), and 1.53 (95% CI, 1.11 - 2.11), respectively, across the ascending glycemia risk index quartiles. Results also showed the risk of diabetic retinopathy was increased by 20% (HR, 1.20; 95% CI, 1.07 - 1.33) per 1-SD increase in glycemia risk index, after adjustment for confounders.

Regarding time-in-range, per 1-SD decrease was associated with a 23% (HR, 1.23; 95% CI, 1.10 - 1.37) increased risk of diabetic retinopathy. Investigators noted there was no statistically significant difference in risk discrimination for incident diabetic retinopathy when using glycemia risk index and time-in-range, as measured by C-statistic, integrated discrimination improvement, and net reclassification improvement (all P >.05), after adjustment for confounders.


  1. Wang Y, Liu J, Ni J, Wang M, Shen Y, Lu W, Zhu W, Bao Y, Rodbard D, Vigersky RA, Jia W, Zhou. Association between Glycemia Risk Index (GRI) and Diabetic Retinopathy in Type 2 Diabetes—A Prospective Cohort Study. Poster presented at: the 83rd Scientific Sessions of the American Diabetes Association. June 23 – 26, 2023.
  2. Klonoff DC, Wang J, Rodbard D, et al. A Glycemia Risk Index (GRI) of Hypoglycemia and Hyperglycemia for Continuous Glucose Monitoring Validated by Clinician Ratings. Journal of Diabetes Science and Technology. 2022;0(0). doi:10.1177/19322968221085273COPY CITATION