Continuous Glucose Monitoring Significantly Reduces Glycemic Risk for Type 1 Diabetes

Recent clinical findings are providing pharmacists with a more nuanced way to evaluate the success of continuous glucose monitoring (CGM) beyond the traditional reliance on glycated hemoglobin. Although hemoglobin A_1C has long served as the gold-standard biomarker for assessing long-term complication risks, it often fails to capture the granular, day-to-day glucose patterns necessary for individualized management.¹

To bridge this gap, the Glycemia Risk Index has emerged as a sophisticated composite metric that offers a single numerical summary of glycemic quality. New data from the GOLD (NCT02092051) trial indicates that adults with type 1 diabetes (T1D) who transition from traditional self-monitoring of blood glucose to continuous glucose monitoring experience a significant reduction in their overall glycemic risk.

“In the GOLD trial, we previously demonstrated that transitioning from self-monitoring of blood glucose (SMBG) to CGM improved HbA1c, TIR, treatment satisfaction, hypoglycaemia confidence, and well-being in adults with T1D using multiple daily insulin injection (MDI) therapy,” the study authors said.¹ “Further analyses showed that individuals with higher baseline HbA1c, greater TAR stage 2, lower TBR stage 1 and 2, and lower coefficient of variation (CV) experienced greater HbA1c reductions after switching to CGM.”

The Glycemia Risk Index operates on a scale of 0 to 100, deriving its score from weighted evaluations of time spent in very low, low, high, and very high glucose ranges. Unlike time in range, which provides a straightforward summary of exposure, the Glycemia Risk Index assigns greater weight to more pronounced deviations, particularly hypoglycemia.

In the GOLD trial, which followed 125 adults using multiple daily insulin injections, the transition to CGM reduced the overall index by nearly ten units. Notably, this improvement was driven by decreases in both hypoglycemia and hyperglycemia components, though the reduction in low-glucose risk was particularly pronounced.

For pharmacists, these findings underscore the clinical value of continuous glucose monitoring as a tool that is more responsive to treatment changes than time in range alone. The research suggests that the Glycemia Risk Index may be especially useful in primary care settings, where clinicians must quickly assess a patient’s glycemic quality amidst a wide range of other health indicators. By using the index's 2-dimensional grid, a pharmacist can rapidly determine whether a patient’s poor control is driven mainly by high or low excursions, allowing for more targeted counseling on insulin dosing or lifestyle adjustments.

“Both the total score and its hypo- and hyper- glycaemia components decreased, with the most pronounced reduction in hypoglycaemia risk,” the study authors said.

The benefits of early intervention are echoed across the lifespan of patients with T1D. A multicenter analysis of over 4000 children and adolescents found that those who initiated CGM within the first 6 months of diagnosis maintained significantly lower A_1C levels 3 years later. This highlights the critical role pharmacists play in the new-onset period, where providing education and ensuring technology access can set the trajectory for long-term health. Furthermore, research into young adults aged 18 to 25 years showed that this demographic experienced some of the greatest improvements in metabolic control when using these sensors, seeing A_1C reductions of up to 15%.^2,3

Despite these clear clinical advantages, structural barriers remain a significant hurdle for many patients. Data from the T1D Exchange Quality Improvement Collaborative reveals disparities in technology access, with patients on public health insurance being significantly less likely to initiate CGM early compared to those with private insurance. Pharmacists are uniquely positioned to advocate for policy changes, such as pushing for these devices to be covered as a universal pharmacy benefit rather than as durable medical equipment. Such a shift would not only improve timely access for marginalized populations but also reduce the prescribing burden for health care providers.²

Beyond clinical metrics, individual psychological traits also appear to influence how effectively an adult manages their glycemic risk. Exploratory analyses from the GOLD trial found that individuals who described themselves as thorough saw greater reductions in hypoglycemia risk, whereas those who reported being easily distracted saw smaller improvements.¹

This suggests that a one-size-fits-all approach to patient education may be insufficient. Pharmacists who understand these behavioral nuances can better tailor their support, providing more intensive follow-up for patients who may struggle with the complexities of carbohydrate counting or insulin adjustment.

Ultimately, the Glycemia Risk Index serves as a valuable complementary tool in the pharmacist's clinical toolkit, integrating the risks of both glycemic extremes into a single, actionable score. Although conventional metrics like time in range remain essential for everyday decision-making due to their simplicity, the composite nature of the index provides a more sensitive measure for evaluating the success of technological interventions.

As diabetes care continues to evolve, the integration of these sophisticated metrics will be vital in helping pharmacists ensure that their patients are not just staying within an average range but are truly minimizing their long-term clinical risk.

READ MORE: Insulin Management Resource Center

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REFERENCES

1. Pylov D, Sterner Isaksson S, Imberg H, Klonoff D, Lind M. Impact of continuous glucose monitoring on glycaemic risk index in adults with type 1 diabetes using multiple daily insulin injections in the GOLD trial. Front Clin Diabetes Healthc. 2026;7:1767987. Published 2026 Mar 4. doi:10.3389/fcdhc.2026.1767987

2. Rubelj K, Stipančić G, La Grasta Sabolić L, Požgaj Šepec M. Continuous glucose monitoring and type 1 diabetes mellitus control in child, adolescent and young adult population - arguments for its use and effects. Acta Clin Croat. 2021;60(4):609-616. doi:10.20471/acc.2021.60.04.07

3. Mann EA, Rompicherla S, Miyazaki B, et al. Early Continuous Glucose Monitor Use in Children and Adolescents With Type 1 Diabetes: Rates of Initiation and Impact on Glycemic Outcomes. Diabetes Care. 2025;48(5):768-775. doi:10.2337/dc25-0076