Updated glucose management indicator (GMI) better aligns with HbA1c than current GMI: implications for clinical practice and reporting
Authors' conclusion
Compared with the CGM-derived GMI, the uGMI provides more accurate and consistent agreement with HbA1c, particularly at lower (<42mmol/mol or 6% NGSP) and higher (>58 mmol/mol or 7.5% NGSP) HbA1c levels.
Study context
- Population
- People with diabetes using continuous glucose monitoring (CGM) (Abbott Freestyle Libre and Dexcom), with AG-HbA1c pairs
- Participants
- 18,860 people26,647 AG-HbA1c pairs
- Comparison
- Updated GMI vs current GMI
- Outcome
- Agreement between GMI and HbA1c across clinically relevant glucose ranges (biases in various ranges)
Methodological detailsclinical trial and real-world data, 100 equal-sized data bins
- Clinical trial and real-world data
- 100 equal-sized data bins
Performance
As reported in the abstract
Regression slope of HbA1c vs GMI
Updated GMI (uGMI)
1.0
GMI
1.4
P < 0.0001
Further findings
Absolute bias at HbA1c below 31 mmol/mol (5.5% NGSP) and above 75 mmol/mol (9.0% NGSP)
- Absolute bias reduced from >4.4 mmol/mol (0.4% NGSP) to ≤1.1 mmol/mol (0.1% NGSP)
Performance across CGM devices
- Consistent performance across both Abbott Freestyle Libre and Dexcom CGM devices; uGMI robust and device-independent
Original publication
Updated glucose management indicator (GMI) better aligns with HbA1c than current GMI: implications for clinical practice and reporting. Diabetologia. Published 24 April 2026. doi:10.
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