For decades, HbA1c has reigned supreme as the gold standard for assessing blood sugar control in individuals with diabetes. However, the landscape is evolving. With the increased use of continuous glucose monitoring (CGMs), time in range (TIR) emerged as a valuable additional metric. And in the last few years, a new contender for interpreting CGM data has entered the ring: the Glycemia Risk Index (GRI).
Read more about GRI and the doctors & researchers who have spearheaded this innovative new metric here.
Why the Need for a New Metric?
While CGM provides valuable insights into blood sugar fluctuations, current metrics such as TIR can pose challenges in interpretation, particularly for non-specialists. Additionally, TIR alone does not reveal the specific areas where a patient might be facing challenges. For instance, a patient with a TIR of 70% might seem to be on target – yet the context changes significantly if the remaining 30% comprises hypoglycemia or hyperglycemia, along with the severity of these episodes. This complexity can mask important data insights and hinder effective diabetes management.
GRI: A Game-Changer
GRI stands out as a single score that amalgamates various CGM metrics, including time spent in very low/low and very high/high ranges, presenting an overview of the overall quality of glycemic control. When depicted on a risk-stratified graph, this provides clinicians with immediate insights into the patient's overall glycemic health through a single numerical score, as well as the contributions of hypoglycemic and hyperglycemic events to that score. This simplification aids in interpretation and offers a clearer understanding of a patient's glycemic journey.
How Is GRI Calculated?
GRI is calculated using a weighted formula that takes into account different glucose ranges and their associated risks. The formula combines various parameters such as time spent in hypoglycemia (very low and low ranges) and hyperglycemia (very high and high ranges), assigning weights based on the severity and impact of these glucose fluctuations, the researchers wrote.
GRI=(3.0×VLow)+(2.4×Low)+(1.6×VHigh)+(0.8×High)
Time spent in very low (<54 mg/dL) and high (54-69 mg/dL) are given the greatest weight, followed by very high (>250 mg/dL) and high (181-250 mg/dL). A higher GRI score indicates poorer glycemic control, with more time spent in risky glucose ranges. Conversely, a lower GRI score suggests better glycemic control, with less time spent in problematic glucose ranges.
As mentioned above, to visually represent the GRI and its implications, GRI is plotted on a risk-stratified graph. The hypoglycemic component is plotted on the x-axis, and the hyperglycemic component is plotted on the y-axis. Each point on the graph represents a specific GRI score for a patient. The graph allows for single glance insights into not only the GRI score and risk-band (based on risk percentile), but contribution of the hypoglycemic and hyperglycemic components. When tracked with multiple inputs, overtime, this becomes even more powerful, offering a clearer picture of glycemic patterns and areas needing attention.
SweetSpot & GRI: A Visual Representation for Actionable Insights
At SweetSpot, we are the only diabetes management platform leveraging GRI for quick powerful data insights. To empower you to stay ahead of the curve, here's how SweetSpot utilizes GRI and its potential benefits for your patients:
On our comprehensive data dashboard, you can easily triage patients based on their GRI by using our filtering and sorting features to view the most at-risk patients based on this single metric.
While the raw GRI score is helpful, the metrics full potential is only unlocked when it is appropriately graphed (as explained above). That’s why we’ve baked in the full GRI risk-stratified graph into SweetSpot dashboard. With the hypoglycemia component on the X-axis and the hyperglycemia component on the Y-axis, this graph is divided into five zones, each representing a percentile of GRI scores. Zone A signifies the best glycemic control, while Zone E indicates the need for significant improvement. Each patient's data point is plotted on the graph, providing a clear visual representation of their overall GRI score and the relative contribution of hypoglycemia and hyperglycemia to their risk profile.
This visual representation empowers you to not only understand a patient's current GRI score but also track their progress over time. By observing how their data point moves within the graph, you can gain valuable insights into how their overall glycemic control is changing, as well as any shifts in the balance between hypoglycemia and hyperglycemia.
By embracing GRI and its visualization through SweetSpot, you can unlock a deeper understanding of your patients' glycemic health, enabling personalized and proactive diabetes management. Remember, staying ahead of the curve in this rapidly evolving landscape can significantly impact your patients' well-being.
Want to learn more about SweetSpot and how we are revolutionizing diabetes management? Check out our website or shoot us a message at info@sweetspot.health.
SweetSpot is a remote diabetes management platform that integrates with multiple CGM and insulin delivery devices, like Dexcom, FreeStyle Libre, Tandem, Medtronic, and more, to provide physicians with a single view of their patients’ data. SweetSpot's intelligent algorithm identifies the most optimal CPT codes for both remote and in-person diabetes management, and a dedicated team of Certified Diabetes Care & Education Specialists are available to provide ongoing support.
As a company founded and powered by physicians and diabetes care providers, we place a strong emphasis on ensuring that there are no obstacles to getting started with SweetSpot. That’s why SweetSpot is easy to set up and designed to seamlessly integrate into your existing workflows and comes with no setup costs or subscription fees.
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