ArticleJournal of diabetes science and technology2023
A Glycemia Risk Index (GRI) of Hypoglycemia and Hyperglycemia for Continuous Glucose Monitoring Validated by Clinician Ratings.
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Article in Journal of diabetes science and technology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 121 papers, 1 of them a synthesis that pooled it.
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121citing papers in PubMed, 1 pooled it
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Who cites it
121 citing papers in PubMed, 1 synthesis or guideline pooled it, 262 citations in OpenAlex.
- Efficacy and Safety of Automated Insulin Delivery Systems in Patients with Type 1 Diabetes Mellitus: A Systematic Review and Meta-Analysis.Diabetes & metabolism journal · 2025Pooled it
- Threshold and Predictive Alerts of Continuous Glucose Monitoring and Glycemic Control in Hospitalized Adults With Diabetes: A Randomized Clinical Trial.JAMA network open · 2026Trial
- The impact of automated insulin delivery on glucose management in people with diabetes and advanced chronic kidney disease.Diabetologia · 2026Trial
- Insulin therapy DE-intensificAtion with iGlarLixi: A phase 4, open-label, parallel-group randomised controlled trial.Diabetes, obesity & metabolism · 2026Trial
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- DASH4D diet for glycemic control and glucose variability in type 2 diabetes: a randomized crossover trial.Nature medicine · 2025Trial
- Comparison of glucose fluctuation between metformin combined with acarbose or sitagliptin in Chinese patients with type 2 diabetes: A multicenter, randomized, active-controlled, open-label, parallel design clinical trial.Chinese medical journal · 2025Trial
- Telehealth occupational therapy improves psychosocial well-being but not glycemia among young adults with type 1 diabetes: The Resilient, Empowered, Active Living-Telehealth (REAL-T) randomized controlled trial.Diabetes research and clinical practice · 2025Trial
- Low-carbohydrate diet proved effective and safe for youths with type 1 diabetes: A randomised trial.Acta paediatrica (Oslo, Norway : 1992) · 2025Trial
- A new approach in insulin pump education improves glycemic outcomes: a randomized controlled trial.Acta diabetologica · 2025Trial
- Trial
- Psychometric Properties of the Automated Insulin Delivery: Benefits and Burdens Scale for Adults with Type 1 Diabetes.Diabetes technology & therapeutics · 2024Trial
- Hybrid Closed-Loop Versus Manual Insulin Delivery in Adults With Type 1 Diabetes: A Post Hoc Analysis Using the Glycemia Risk Index.Journal of diabetes science and technology · 2024Trial
- Trial
- Remote glucose monitoring is feasible for patients and providers using a commercially available population health platform.Frontiers in endocrinology · 2023Trial
- What Is a Clinically Meaningful Change in Diabetes Distress? Findings for Diabetes Care and Research From the SFDT1 Cohort.Diabetes, obesity & metabolism · 2026Article
- Tirzepatide for Excess Weight in Adults With Type 1 Diabetes Using MiniMed 780G.Diabetes, obesity & metabolism · 2026Article
- Degree of islet function preservation and continuous glucose monitoring in individuals undergoing total pancreatectomy with islet autotransplantation.Diabetologia · 2026Article
- Twenty-four-month evaluation of the glycemia risk index in adults with type 1 diabetes using advanced hybrid closed-loop systems.Endocrine · 2026Observational
- Article
61 more citing papers are in PubMed but not listed here.
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Authors and funding
94 authors at 20 institutions in 20 countries.
David C KlonoffDiabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA.ORCID 0000-0001-6394-6862
Jing WangFlorida State University College of Nursing, Tallahassee, FL, USA.ORCID 0000-0002-4012-0977
David RodbardBiomedical Informatics Consultants LLC, Potomac, MD, USA.ORCID 0000-0002-5547-3564
Michael A KohnUniversity of California, San Francisco, San Francisco, CA, USA.ORCID 0000-0001-5459-5044
Chengdong LiFlorida State University College of Nursing, Tallahassee, FL, USA.ORCID 0000-0001-5330-9624
Dorian LiepmannUniversity of California, Berkeley, Berkeley, CA, USA.ORCID 0000-0002-2591-4031
David KerrSansum Diabetes Research Institute, Santa Barbara, CA, USA.ORCID 0000-0003-1335-1857
David AhnHoag Memorial Hospital Presbyterian, Newport Beach, CA, USA.ORCID 0000-0002-8941-8459
Anne L PetersUniversity of Southern California, Los Angeles, CA, USA.ORCID 0000-0003-0520-0776
Guillermo E UmpierrezEmory University, Atlanta, GA, USA.ORCID 0000-0002-3252-5026
Jane Jeffrie SeleyWeill Cornell Medicine, New York, NY, USA.ORCID 0000-0003-1582-4320
Nicole Y XuDiabetes Technology Society, Burlingame, CA, USA.ORCID 0000-0001-9353-8819
Kevin T NguyenDiabetes Technology Society, Burlingame, CA, USA.ORCID 0000-0001-9102-6537
Gregg SimonsonInternational Diabetes Center, Minneapolis, MN, USA.ORCID 0000-0001-5561-2547
Michael S D AgusBoston Children's Hospital, Harvard Medical School, Boston, MA, USA.ORCID 0000-0001-6454-6828
Mohammed E Al-SofianiKing Saud University, Riyadh, Saudi Arabia.ORCID 0000-0003-4420-9378
Gustavo Armaiz-PenaUT Health San Antonio, San Antonio, TX, USA.ORCID 0000-0001-9652-9010
Timothy S BaileyAMCR Institute, Escondido, CA, USA.ORCID 0000-0003-4178-3462
Ananda BasuUniversity of Virginia, Charlottesville, VA, USA.ORCID 0000-0003-4166-6741
Tadej BattelinoFaculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.ORCID 0000-0002-0273-4732
Sewagegn Yeshiwas BekeleAddis Ababa University, Addis Ababa, Ethiopia.ORCID 0000-0002-8153-7672
Pierre-Yves BenhamouCentre Hospitalier Universitaire de Grenoble, Grenoble, France.ORCID 0000-0003-4378-0468
B Wayne BequetteRensselaer Polytechnic Institute, Troy, NY, USA.ORCID 0000-0002-6472-1902
Thomas BlevinsTexas Diabetes and Endocrinology, Austin, TX, USA.ORCID 0000-0003-3746-9606
Marc D BretonUniversity of Virginia, Charlottesville, VA, USA.ORCID 0000-0001-7645-2693
Jessica R CastleOregon Health & Science University, Portland, OR, USA.ORCID 0000-0003-1179-5374
James Geoffrey ChaseUniversity of Canterbury, Christchurch, New Zealand.ORCID 0000-0001-9989-4849
Kong Y ChenNational Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA.ORCID 0000-0002-0306-1904
Pratik ChoudharyUniversity of Leicester, Leicester, UK.ORCID 0000-0001-7635-4735
Mark A ClementsChildren's Mercy Hospital, Kansas City, MO, USA.ORCID 0000-0002-2368-0331
Kelly L CloseClose Concerns, San Francisco, CA, USA.ORCID 0000-0001-7332-1380
Curtiss B CookMayo Clinic Arizona, Scottsdale, AZ, USA.ORCID 0000-0001-5885-9959
Thomas DanneDiabetes Center Auf der Bult, Hannover Medical School, Hannover, Germany.
Francis J DoyleHarvard University, Cambridge, MA, USA.ORCID 0000-0002-3293-9114
Angela DrincicUniversity of Nebraska, Omaha, NE, USA.ORCID 0000-0001-8365-7662
Kathleen M DunganThe Ohio State University, Columbus, OH, USA.ORCID 0000-0003-1289-1595
Steven V EdelmanUniversity of California, San Diego, San Diego, CA, USA.ORCID 0000-0002-0760-9332
Niels EjskjaerSteno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark.ORCID 0000-0003-3749-3403
Juan C EspinozaChildren's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA.ORCID 0000-0003-0513-588X
G Alexander FlemingKinexum, Harpers Ferry, WV, USA.ORCID 0000-0002-6549-0288
Gregory P ForlenzaBarbara Davis Center for Diabetes, University of Colorado, Aurora, CO, USA.ORCID 0000-0003-3607-9788
Guido FreckmannInstitute for Diabetes-Technology GmbH, Ulm, Germany.ORCID 0000-0002-0406-9529
Rodolfo J GalindoEmory University, Atlanta, GA, USA.ORCID 0000-0002-9295-3225
Ana Maria GomezPontificia Universidad Javeriana, Bogotá, Colombia.ORCID 0000-0002-5273-7018
Hanna A GutowClose Concerns, San Francisco, CA, USA.ORCID 0000-0001-9067-898X
Lutz HeinemannScience Consulting in Diabetes GmbH, Kaarst, Germany.ORCID 0000-0003-2493-1304
Irl B HirschUniversity of Washington, Seattle, WA, USA.ORCID 0000-0003-1675-8417
Thanh D HoangWalter Reed National Military Medical Center, Bethesda, MD, USA.ORCID 0000-0001-7437-5604
Roman HovorkaUniversity of Cambridge, Cambridge, UK.ORCID 0000-0003-2901-461X
Johan H JendleÖrebro University, Örebro, Sweden.ORCID 0000-0003-1025-1682
Linong JiPeking University People's Hospital, Peking University Diabetes Center, Beijing, China.ORCID 0000-0003-1305-1598
Shashank R JoshiJoshi Clinic, Mumbai, India.ORCID 0000-0002-0990-5821
Michael JoubertCaen University Hospital, Caen, France.ORCID 0000-0002-8731-7355
Suneil K KoliwadUniversity of California, San Francisco, San Francisco, CA, USA.ORCID 0000-0002-7367-1054
Rayhan A LalStanford University, Stanford, CA, USA.ORCID 0000-0002-8055-944X
M Cecilia LansangCleveland Clinic, Cleveland, OH, USA.ORCID 0000-0002-7364-5550
Wei-An Andy LeeLAC + USC Medical Center, Los Angeles County Department of Health Service, Los Angeles, CA, USA.ORCID 0000-0002-2928-7338
Lalantha LeelarathnaManchester University NHS Foundation Trust and The University of Manchester, Manchester, UK.ORCID 0000-0001-9602-1962
Lawrence A LeiterLi Ka Shing Knowledge Institute, St. Michael's Hospital and University of Toronto, Toronto, ON, Canada.ORCID 0000-0002-1040-6229
Marcus LindUniversity of Gothenburg, Gothenburg, Sweden.ORCID 0000-0002-3796-9283
Michelle L LitchmanThe University of Utah College of Nursing, Salt Lake City, UT, USA.ORCID 0000-0002-8928-5748
Julia K MaderMedical University of Graz, Graz, Austria.ORCID 0000-0001-7854-4233
Katherine M MahoneyClose Concerns, San Francisco, CA, USA.ORCID 0000-0002-5857-386X
Boris MankovskyNational Healthcare University of Ukraine, Kiev, Ukraine.ORCID 0000-0001-8289-3604
Umesh MasharaniUniversity of California, San Francisco, San Francisco, CA, USA.ORCID 0000-0002-3269-804X
Nestoras N MathioudakisJohns Hopkins University, Baltimore, MD, USA.ORCID 0000-0002-0210-655X
Alexander MayorovEndocrinology Research Centre, Moscow, Russian Federation.ORCID 0000-0001-5825-3287
Jordan MesslerMorton Plant Hospital, Clearwater, FL, USA.ORCID 0000-0002-3080-6940
Joshua D MillerStony Brook University, Stony Brook, NY, USA.ORCID 0000-0001-9512-461X
Viswanathan MohanDr. Mohan's Diabetes Specialities Centre, Chennai, India.ORCID 0000-0001-5038-6210
James H NicholsVanderbilt University Medical Center, Nashville, TN, USA.ORCID 0000-0002-3652-1612
Kirsten NørgaardSteno Diabetes Center Copenhagen, Herlev, Denmark.ORCID 0000-0003-1620-8271
David N O'NealUniversity of Melbourne, Melbourne, VIC, Australia.ORCID 0000-0002-0870-4032
Francisco J PasquelEmory University, Atlanta, GA, USA.ORCID 0000-0002-3845-6703
Athena Philis-TsimikasScripps Whittier Diabetes Institute, San Diego, CA, USA.ORCID 0000-0002-3986-9630
Thomas PieberMedical University of Graz, Graz, Austria.ORCID 0000-0003-3554-0405
Moshe PhillipInstitute for Endocrinology and Diabetes, Schneider Children's Medical Center of Israel and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.ORCID 0000-0002-6616-5612
William H PolonskyBehavioral Diabetes Institute, San Diego, CA, USA.ORCID 0000-0001-9064-6144
Rodica Pop-BusuiUniversity of Michigan, Ann Arbor, MI, USA.ORCID 0000-0002-2042-1350
Gerry RaymanIpswich Hospital, East Suffolk and North Essex Foundation Trust and University of East Anglia, Ipswich, UK.ORCID 0000-0003-3331-7015
Eun-Jung RheeKangbuk Samsung Hospital, Sungkyunkwan University, Seoul, Korea.ORCID 0000-0002-6108-7758
Steven J RussellMassachusetts General Hospital Diabetes Research Center, Boston, MA, USA.ORCID 0000-0001-8423-5891
Viral N ShahBarbara Davis Center for Diabetes, University of Colorado, Aurora, CO, USA.ORCID 0000-0002-3827-7107
Jennifer L SherrYale University, New Haven, CT, USA.ORCID 0000-0001-9301-3043
Koji SodeThe University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.ORCID 0000-0002-9833-2091
Elias K SpanakisUniversity of Maryland, Baltimore, MD, USA.ORCID 0000-0002-9352-7172
Deborah J WakeThe University of Edinburgh, Edinburgh, UK.ORCID 0000-0003-4376-6973
Kayo WakiThe University of Tokyo, Tokyo, Japan.ORCID 0000-0003-0046-2523
Amisha WalliaNorthwestern University, Chicago, IL, USA.ORCID 0000-0002-3183-4062
Melissa E WeinbergCalifornia Pacific Medical Center, San Francisco, CA, USA.ORCID 0000-0003-2723-5865
Howard WolpertBoston Medical Center, Boston, MA, USA.ORCID 0000-0001-9771-6344
Eugene E WrightCharlotte AHEC, Charlotte, NC, USA.ORCID 0000-0003-0796-0496
Mihail ZilbermintJohns Hopkins University, Baltimore, MD, USA.ORCID 0000-0003-4047-7260
Boris KovatchevUniversity of Virginia, Charlottesville, VA, USA.ORCID 0000-0003-0495-3901
Close Concerns (United States) · USEmory University · USJohns Hopkins University · USUniversity of California, San Francisco · USUniversity of Virginia · USDiabetes Technology Society · USFlorida State University · USMedical University of Graz · ATSteno Diabetes Centers · DKUniversity of Colorado Anschutz Medical Campus · USUniversity of Southern California · USAddis Ababa University · ETAMCR Institute · USBoston Children's Hospital · USBoston Medical Center · USCalifornia Pacific Medical Center · USCentre Hospitalier Universitaire de Grenoble · FRChildren's Mercy Hospital · USCleveland Clinic · USCornell University · US
Funding
Yale Clinical and Translational Science Award (U Component)UL1TR001863 · NCATS · YALE UNIVERSITY · PI John H. Krystal, LUCILA OHNO-MACHADO · 2016 to 2026
$102.9MSouthern California Clinical and Translational Science InstituteUL1TR001855 · NCATS · UNIVERSITY OF SOUTHERN CALIFORNIA · PI Thomas A Buchanan, Michele D. Kipke · 2016 to 2026
$81.3MYale Diabetes Research CenterP30DK045735 · NIDDK · YALE UNIVERSITY · PI Kevan C Herold, GERALD I SHULMAN · 1993 to 2026
$44.0MSouthern California Clinical and Translational Science InstituteUL1TR000130 · NCATS · UNIVERSITY OF SOUTHERN CALIFORNIA · PI BUCHANAN, THOMAS A · 2012 to 2015
$36.0MRegional Pilot And Feasibility Study Grants ProgramP30DK020572 · NIDDK · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI DAVID P OLSON · 2013 to 2026
$24.3MUCSF Nutrition Obesity Research CenterP30DK098722 · NIDDK · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI CHRISTIAN VAISSE · 2015 to 2026
$14.6MTranslational Research Core - Engagement and Behavior ChangeP30DK111024 · NIDDK · EMORY UNIVERSITY · PI Mohammed Kumail Ali · 2016 to 2026
$13.4MDevelopment of obesity and metabolic clinical research programsZIADK071014 · NIDDK · NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES · PI CHEN, KONG · 2009 to 2025
$12.3MImproving intensive insulin therapy through the personalization of data-driven decision support system to patients’ goals and preferences and its adaptation to long term health needsR01DK051562 · NIDDK · UNIVERSITY OF VIRGINIA CHARLOTTESVILLE · PI MARC D BRETON, Chiara Fabris · 1996 to 2026
$9.4MNew York Regional Center for Diabetes Translation Research - Translational Intervention Methodology CoreP30DK111022 · NIDDK · ALBERT EINSTEIN COLLEGE OF MEDICINE, INC · PI JEFFREY GONZALEZ · 2016 to 2026
$7.8MUse of Continuous Glucose Monitoring (CGM) in End-Stage Renal Disease(ESRD) Patients with Type 2 DiabetesK23DK123384 · NIDDK · UNIVERSITY OF MIAMI SCHOOL OF MEDICINE · PI GALINDO, RODOLFO · 2020 to 2024
$934kContinuous Glucose Monitoring in Insulin Treated Hospitalized Veterans with DM2 at Higher Risk for HypoglycemiaI01CX001825 · VA · BALTIMORE VA MEDICAL CENTER · PI SPANAKIS, ILIAS · 2018 to 2023
–CSRD VA I01 CX001825FDA HHS P50 FD006425NCATS NIH HHS UL1 TR000130NCATS NIH HHS UL1 TR001855NCATS NIH HHS UL1 TR001863NIDDK NIH HHS K23 DK123384NIDDK NIH HHS P30 DK020572NIDDK NIH HHS P30 DK045735NIDDK NIH HHS P30 DK098722NIDDK NIH HHS P30 DK111022NIDDK NIH HHS P30 DK111024NIDDK NIH HHS R01 DK051562
Abstract
backgroundA composite metric for the quality of glycemia from continuous glucose monitor (CGM) tracings could be useful for assisting with basic clinical interpretation of CGM data.
methodsWe assembled a data set of 14-day CGM tracings from 225 insulin-treated adults with diabetes. Using a balanced incomplete block design, 330 clinicians who were highly experienced with CGM analysis and interpretation ranked the CGM tracings from best to worst quality of glycemia. We used principal component analysis and multiple regressions to develop a model to predict the clinician ranking based on seven standard metrics in an Ambulatory Glucose Profile: very low-glucose and low-glucose hypoglycemia; very high-glucose and high-glucose hyperglycemia; time in range; mean glucose; and coefficient of variation.
resultsThe analysis showed that clinician rankings depend on two components, one related to hypoglycemia that gives more weight to very low-glucose than to low-glucose and the other related to hyperglycemia that likewise gives greater weight to very high-glucose than to high-glucose. These two components should be calculated and displayed separately, but they can also be combined into a single Glycemia Risk Index (GRI) that corresponds closely to the clinician rankings of the overall quality of glycemia (r = 0.95). The GRI can be displayed graphically on a GRI Grid with the hypoglycemia component on the horizontal axis and the hyperglycemia component on the vertical axis. Diagonal lines divide the graph into five zones (quintiles) corresponding to the best (0th to 20th percentile) to worst (81st to 100th percentile) overall quality of glycemia. The GRI Grid enables users to track sequential changes within an individual over time and compare groups of individuals.
conclusionThe GRI is a single-number summary of the quality of glycemia. Its hypoglycemia and hyperglycemia components provide actionable scores and a graphical display (the GRI Grid) that can be used by clinicians and researchers to determine the glycemic effects of prescribed and investigational treatments.
Indexed as
HyperglycemiaHypoglycemiaAdultBlood GlucoseBlood Glucose Self-MonitoringGlucoseHumansBlood GlucoseGlucoseambulatory glucose profilecomposite metriccontinuous glucose monitordiabetesglycemia risk indexhyperglycemiahypoglycemiatime in range
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