Association of continuous glucose monitoring metrics with cardiovascular and kidney outcomes in type 2 diabetes: Data from the GRADE-CGM substudy.
Mengyao Tang, David M Nathan, Deborah J Wexler et al.
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In 30 seconds
This analysis of the GRADE-CGM substudy examined whether blinded continuous glucose monitoring (CGM) metrics were associated with cardiovascular events or death and kidney function decline in 1,363 people with type 2 diabetes. Over a median 2.3 years, 74 cardiovascular events or deaths occurred. GMI, HbA1c, and time in range (TIR) were each associated with the cardiovascular/death composite: adjusted hazard ratios were 1.44 per 1% higher GMI, 1.37 per 1% higher HbA1c, and 0.73 per 20% higher TIR. GMI and HbA1c, but not TIR, were associated with eGFR decline.
Key findings
- Per 1% higher GMI, the adjusted hazard ratio for cardiovascular events or death was 1.44 [1.21-1.71].
- Per 1% higher HbA1c, the adjusted hazard ratio for cardiovascular events or death was 1.37 [1.16-1.61].
- Per 20% higher TIR, the adjusted hazard ratio for cardiovascular events or death was 0.73 [0.61-0.87].
- Higher GMI and HbA1c were associated with faster eGFR decline; TIR was not significantly associated with eGFR slope.
Why it matters
The findings suggest that CGM-derived GMI and TIR capture information associated with cardiovascular risk in type 2 diabetes, while GMI and HbA1c showed similar associations with both cardiovascular and kidney outcomes. The distinction between TIR’s cardiovascular association and its lack of a significant eGFR-slope association is relevant when interpreting CGM metrics across different outcomes.
What to keep in mind
The analysis had a median follow-up of 2.3 years and 74 cardiovascular events or deaths. Associations were attenuated after mutual adjustment of CGM metrics and HbA1c.