Glycemia Risk Index – An Emerging Measurement to Complement Your TIR
By Matthew Garza
Time in Range (TIR) is a well established and easy to use measurement of your daily glucose management. The glycemia risk index (or dysglycemia index) is an emerging measurement, currently being researched, that combines seven of your CGM metrics, including TIR, into a numeric score that your healthcare provider can use to quickly identify areas for adjustments within your glucose management.
Time in Range (TIR) is an easy way to understand your glucose values by telling you how much time you spend in a target glucose range every day (for most people this is between 70 and 180 mg/dL). In addition, TIR can give you daily insights into how everyday decisions impact your glucose (from meals to exercise to medications and more).
TIR is an invaluable tool for people with diabetes, but when it comes time for an appointment with your healthcare team – a jam-packed visit that may only last 15 minutes – it may be hard to dissect all that information with your healthcare provider, or compare multiple ambulatory glucose profile (AGP) reports (while still leaving time to discuss everything else you need to).
This is where the glycemia risk index could come in. The glycemia risk index is being developed and undergoing extensive research by some of the most influential people in diabetes and in Time in Range – including Dr. Rich Bergenstal, Dr. Anne Peters, Dr. Roy Beck, Dr. Jane Seley, Dr. Boris Kovatchev, and many more. At the Virtual Diabetes Technology Meeting on Nov. 5, 2021, the president of the Diabetes Technology Society, Dr. David Klonoff delivered a presentation on this new measurement.
The glycemia risk index takes into account the following measurements:
Time in Range
Time spent in severe hypoglycemia (less than 54 mg/dL)
Time spent in hypoglycemia (less than 70 mg/dL)
Time spent in hyperglycemia (greater than 180 mg/dL)
Time spent in severe hyperglycemia (greater than 250 mg/dL)
And average glucose
It delivers this information as a data point that indicates your exposure to hyperglycemia and hypoglycemia and it may provide another way for your healthcare provider to quickly assess your overall diabetes management and make recommendations based on the score.
While a single data point can never tell you everything you need to know about your glucose levels and diabetes management, in the fast-paced environment of your healthcare provider’s office it may be very helpful.
The research so far shows that a person’s TIR and their glycemia risk index are very strongly associated with each other – and in fact, to calculate the glycemia risk index, researchers have to use your TIR and AGP report because it is grouping seven key AGP metrics into one data point.
This metric could eventually be an exciting addition to TIR and A1C. Though there is still more to be done before this metric is used regularly by healthcare teams – including clinical studies to understand how meaningful this measurement may be, and what, if any, long-term outcomes are associated with it – the glycemia risk index could help providers save time and understand your glucose data with even more clarity.
In 2022, a paper on the glycemic risk index was published in the Journal of Diabetes Science and Technology. Along with this publication, the Diabetes Technology Society made a GRI calculator available on its website for people with diabetes and clinicians to learn more about the index.