Exploration of Clinical Application of Glucose Exposure Risk Index

OBJECTIVES: Prolonged exposure to hyperglycemia and greater fluctuations in blood glucose increase the accumulation of advanced glycation end products (AGEs), leading to the development of various diabetic complications. On the other hand, prolonged and frequent exposure to hypoglycemia can cause significant damage to the nervous system and even be life-threatening.

METHODS: By combining the continuous glucose monitoring (CGM) data of 31 patients with diabetes from county-level areas in China, the study was conducted using 4.5 days of CGM data. Based on this, a product model for curved area and CV was established. H-GERI =AUC_high × CV_high, and L-GERI= AUC_low × CV_low, which were used to evaluate the GERI in patients under different treatment regimens. Additionally, a validation was conducted using data from 29 diabetes patients from a publicly available dataset in Shanghai who also used CGM.

RESULTS: In the basal insulin group, the H-GERI was 34.53±91 and the L-GERI was 0.43±0.13. In the premixed insulin group, the H-GERI was 36.82±2.48 and the L-GERI was 0.56±0.18. Comparing with two groups, the H-GERI (t=1.99,P=0.03), and the L-GERI (t=1.88,P=0.04), indicating that the basal insulin group had better control levels. In the publicly available dataset had 29 cases, including 16 cases used basal insulin and 13 cases used premixed insulin. Compared with two groups, the H-GERI yielded a t-value of 2.47 (P=0.01), and the L-GERI yielded a t-value of 2.10 (P=0.03), which consistent with the results of county-level hospitals in China.

CONCLUSIONS: Patients with diabetes receiving basal insulin therapy showed superior H-GERI and L-GERI compared to those receiving premixed insulin therapy. GERI can be applied as an indicator for evaluating efficacy and safety in diabetes management. Further exploration is needed to optimize the GERI index and investigate its predictive and guiding role in the prognosis of diabetes patients.