Discordance Between HbA1c and Glucose Management Indicator in People With Type 2 Diabetes Treated With SGLT2 Inhibitors
Authors' conclusion
SGLT2i therapy alters the interpretation of glycemic markers by elevating HGI and lowering GA/HbA1c, independent of hematologic and renal factors. These findings emphasize the need for individualized assessment of glycemic control using CGM-derived metrics and complementary biomarkers.
Study context
- Population
- Individuals with T2D with continuous glucose monitoring (CGM) data, stratified by SGLT2i userestricted dataset n = 117
- Participants
- 143 individuals
- Exposure
- SGLT2i users vs non-users
- Outcome
- Hemoglobin glycation index (HGI: HbA1c minus GMI)
Main finding
As reported in the abstract
SGLT2i users
0.3
Non-users
0.1
P = 0.0297
Observational data: associations, not effects.
Further findings
| Outcome | SGLT2i users | Non-users | P value |
|---|---|---|---|
| HGI, restricted dataset (excluding anemia or advanced renal dysfunction) | 0.4 | 0.1 | P = 0.0206 |
| GA/HbA1c ratio, full datasetSignificantly lower with SGLT2i | 2.27 | 2.54 | P = 0.0117 |
| GA/HbA1c ratio, restricted dataset | 2.18 | 2.38 | P = 0.0178 |
HbA1c–glucose management indicator (GMI) and GA–GMI relationships; multivariate analyses
- HbA1c–GMI relationship had significantly different slopes between SGLT2i users and non-users; GA–GMI relationship consistent across groups
- SGLT2i use an independent determinant of higher hemoglobin glycation index (HGI) and lower GA/HbA1c ratio after adjustment for age, sex, body mass index (BMI), hemoglobin, albumin, renal function, mean glucose and glycemic variability
- SGLT2i users exhibited higher hematologic parameters
Original publication
Discordance Between HbA1c and Glucose Management Indicator in People With Type 2 Diabetes Treated With SGLT2 Inhibitors. J Diabetes Sci Technol. Published 28 February 2026. doi:10.
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