{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T08:39:56Z","timestamp":1792571996237,"version":"4.5.0"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T00:00:00Z","timestamp":1762819200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T00:00:00Z","timestamp":1762819200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100011946","name":"Abbott Diabetes Care","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100011946","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Diabetologia"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims\/hypothesis<\/jats:title>\n                    <jats:p>\n                      This study aimed to compare the predictive performance of HbA\n                      <jats:sub>1c<\/jats:sub>\n                      and a continuous glucose monitoring (CGM)-based updated glucose management indicator (uGMI) in assessing incident diabetic retinopathy risk.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We used the data from a previously published longitudinal case\u2013control study that collected CGM data for up to 7 years prior to diagnosis of incident diabetic retinopathy or no retinopathy (control participants) among adults with type 1 diabetes. Mutual information scores (MIS), receiver operating characteristics (ROC) curves and machine learning models were used to assess the associations of diabetic retinopathy with HbA\n                      <jats:sub>1c<\/jats:sub>\n                      , uGMI and CGM-derived metrics.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The uGMI demonstrated a stronger association with incident diabetic retinopathy (MIS 0.148) compared with HbA\n                      <jats:sub>1c<\/jats:sub>\n                      (MIS 0.078). ROC analysis showed that uGMI had a modestly higher AUC (AUC 0.733) than HbA\n                      <jats:sub>1c<\/jats:sub>\n                      (AUC 0.704). Decision tree models incorporating both HbA\n                      <jats:sub>1c<\/jats:sub>\n                      and uGMI did not improve clinically significant diabetic retinopathy risk prediction. Machine learning models confirmed the better predictive value of uGMI, especially for HbA\n                      <jats:sub>1c<\/jats:sub>\n                      values between 54 mmol\/mol (7.1% NGSP) and 58 mmol\/mol (7.5% NGSP), where diabetic retinopathy risk escalated significantly.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions\/interpretation<\/jats:title>\n                    <jats:p>\n                      The uGMI is a slightly stronger predictor of diabetic retinopathy risk compared with HbA\n                      <jats:sub>1c<\/jats:sub>\n                      . HbA\n                      <jats:sub>1c<\/jats:sub>\n                      and uGMI do not appear to be complementary for diabetic retinopathy risk prediction.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s00125-025-06599-w","type":"journal-article","created":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T07:50:45Z","timestamp":1762847445000},"page":"610-617","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Association of HbA1c and an updated glucose management indicator (uGMI) with incident diabetic retinopathy in adults with type 1 diabetes: a longitudinal study"],"prefix":"10.1007","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3827-7107","authenticated-orcid":false,"given":"Viral N.","family":"Shah","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9446-8402","authenticated-orcid":false,"given":"Yongjin","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4778-7501","authenticated-orcid":false,"given":"Yaghoub","family":"Dabiri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8932-7816","authenticated-orcid":false,"given":"Hemanth P.","family":"Mohanadas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7897-4751","authenticated-orcid":false,"given":"Alan","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3487-2504","authenticated-orcid":false,"given":"Timothy C.","family":"Dunn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,11]]},"reference":[{"issue":"14","key":"6599_CR1","doi-asserted-by":"publisher","first-page":"977","DOI":"10.1056\/NEJM199309303291401","volume":"329","author":"Diabetes Control and Complications Trial Research Group","year":"1993","unstructured":"Diabetes Control and Complications Trial Research Group (1993) The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. 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Walker, V. Karne, V. Potluri, M. Pagare, A. Champknathan, B. Wang, P. Joshee and L. Qmara, who were all were working at the Barbara Davis Center for Diabetes, University of Colorado, at the time of the active project, for their help with data collection and data cleaning.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Acknowledgements"}},{"value":"Data can be requested by contacting the corresponding author, indicating details of how the data are to be used. Data may be made available based on institutional agreements.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Data availability"}},{"value":"We used data from a previously published project, which was funded by Breakthrough T1D (grant no. 2-SRA-2021-1069-S-B to VNS). The funder had no role in the current analysis. This work is funded by Abbott Diabetes Care.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Funding"}},{"value":"VNS\u2019s institution has received research support from Dexcom, Eli Lilly, Enable Bioscience, Zucara Therapeutics, the Cystic Fibrosis Research Foundation, Breakthrough T1D and NIH. VNS reports receiving honoraria from Sanofi, NovoNordisk, Eli Lilly, Insulet, Tandem Diabetes Care, Dexcom, Ascensia Diabetes Care, Embecta, Biomea Fusion, Sequel Med Tech, Medtronic, Genomelink and Lumosfit for consultation, advice or speaking roles, outside the submitted work. All other authors are employees of Abbott Diabetes Care.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Authors\u2019 relationships and activities"}},{"value":"VNS collected the data and shared the data with YX, conceived the concept, interpreted the data, and edited this manuscript. YX and TCD conceived the concept and added to the analysis the concept of using uGMI and combining uGMI with HbA\n                      1c\n                      to detect diabetic retinopathy risk. YX and YD analysed the data. HPM, YX, YD, AC and TCD interpreted the data, and drafted and compiled the manuscript. All authors have reviewed and approved the final manuscript for publication. VNS and YX are the guarantors of this work.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Contribution statement"}}]}}