Evidence mapPaperPMID 41366154Full record

Observational studyDiabetes, obesity & metabolism2026

CGM-derived average glucose is more strongly associated with microvascular complications than HbA1c in type 1 diabetes.

Roland H Stimson, Michael S Crane, Anna R Dover, Shareen Forbes, Rohana J Wright, Marcus J Lyall, Mark W J Strachan, Fraser W Gibb

Abstract readObservational StudyComparative Study
In one paragraph

Observational study in Diabetes, obesity & metabolism, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Roland H StimsonEdinburgh Centre for Endocrinology & Diabetes, NHS Lothian, Edinburgh, UK.ORCID 0000-0002-9002-6188
Michael S CraneDepartment of Clinical Biochemistry, NHS Lothian, Edinburgh, UK.
Anna R DoverEdinburgh Centre for Endocrinology & Diabetes, NHS Lothian, Edinburgh, UK.
Shareen ForbesEdinburgh Centre for Endocrinology & Diabetes, NHS Lothian, Edinburgh, UK.
Rohana J WrightEdinburgh Centre for Endocrinology & Diabetes, NHS Lothian, Edinburgh, UK.
Marcus J LyallEdinburgh Centre for Endocrinology & Diabetes, NHS Lothian, Edinburgh, UK.
Mark W J StrachanEdinburgh Centre for Endocrinology & Diabetes, NHS Lothian, Edinburgh, UK.
Fraser W GibbEdinburgh Centre for Endocrinology & Diabetes, NHS Lothian, Edinburgh, UK.ORCID 0000-0002-5576-6463

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsTo compare the associations of HbA1c and continuous glucose monitoring (CGM)-derived average glucose with microvascular complications in adults with type 1 diabetes, and to assess the clinical utility and stability of metrics capturing glycation discordance. MATERIALS AND

methodsObservational assessment of 9023 paired measurements of CGM data (14 days) and HbA1c in 2721 adults with type 1 diabetes. CGM metrics, HbA1c, and markers of discordance between HbA1c and CGM average glucose were associated with prevalent retinopathy (any and proliferative) and microalbuminuria.

resultsHbA1c was higher than expected in older individuals (62 mmol/mol [54-71] age >45 vs. 61 mmol/mol [52-71], p = 0.004) and in women (62 mmol/mol [54-71] vs. 61 mmol/mol [53-71], p < 0.001) despite lower or similar average glucose levels. Fewer than one-third of individuals remain within the same HbA1c-average glucose discordance category over time. HbA1c (p < 0.001), average glucose (p < 0.001), CV glucose (p < 0.001), and socioeconomic deprivation (p = 0.003) were all independently associated with retinopathy risk (with similar results for proliferative retinopathy). Higher glycation was associated with a lower likelihood of prevalent retinopathy (p < 0.001).

conclusionsCGM-derived average glucose appears superior to HbA1c as a marker of prevalent microvascular complications. These data challenge the high-glycator hypothesis and also suggest glucose variability may be an independent risk marker for microvascular disease.

Indexed as

Blood GlucoseBlood Glucose Self-MonitoringDiabetes Mellitus, Type 1Diabetic AngiopathiesDiabetic RetinopathyGlycated HemoglobinAdultAgedAlbuminuriaBiomarkersFemaleHumansMaleMiddle AgedBiomarkersBlood GlucoseGlycated Hemoglobinhemoglobin A1c protein, humancontinuous glucose monitoring (CGM)diabetic retinopathyglycaemic controltype 1 diabetes

Identifiers

PMID41366154
PMCPMC12890757

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.