Continuous glucose monitoring (CGM) ‐derived average glucose is more strongly associated with microvascular complications than HbA1c in type 1 diabetes
Authors' conclusion
CGM-derived average glucose appears superior to HbA1c as a marker of prevalent microvascular complications. These data challenge the high-glycator hypothesis and also suggest glucose variability may be an independent risk marker for microvascular disease.
Study context
- Population
- Adults with T1D9,023 paired measurements
- Participants
- 2,721 adults
- Exposure
- HbA1c vs CGM-derived average glucose as markers of microvascular complications
- Outcome
- Associations of HbA1c and CGM-derived average glucose with prevalent retinopathy (any and proliferative) and microalbuminuria
Methodological detailsobservational, paired CGM (14 days) and HbA1c measurements
- Observational
- Paired CGM (14 days) and HbA1c measurements
Main finding
As reported in the abstract
Prevalent retinopathy
- HbA1c independently associated with retinopathy risk
- p < 0.001
- Average glucose independently associated with retinopathy risk
- p < 0.001
- CV glucose independently associated with retinopathy risk
- p < 0.001
- Socioeconomic deprivation independently associated with retinopathy risk
- p = 0.003
- Higher glycation associated with lower likelihood of prevalent retinopathy
- p < 0.001
Observational data: associations, not effects.
Further findings
Age >45 vs Younger
HbA1c by age (despite lower or similar average glucose) · HbA1c higher than expected in older individuals
P = 0.004
Women vs Men
HbA1c by sex (despite lower or similar average glucose) · HbA1c higher than expected in women
P < 0.001
Stability of HbA1c-average glucose discordance category · over time
- Fewer than one-third remain in the same discordance category over time
Original publication
CGM ‐derived average glucose is more strongly associated with microvascular complications than HbA1c in type 1 diabetes. Diabetes Obes Metab. Published 9 December 2025. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →