Introduction and Objective: While the effect of remote patient monitoring (RPM) on diabetes is typically measured by A1C and TIR, these metrics obscure hypoglycemia and glucose excursions. The Glycemia Risk Index (GRI) is a validated composite metric that integrates both high- and low-glucose exposure to provide a comprehensive assessment of glycemic risk. The GRI stratifies individuals into five risk zones, (A lowest; E highest). However, the durability of RPM impact on GRI transitions is under-characterized. We evaluated the time-dependent impact of a clinically-supported RPM program utilizing continuous glucose monitoring (CGM) on GRI transition zones in a real-world cohort.Methods: We performed a retrospective analysis of 1,371 adults with diabetes who enrolled in an RPM program, stratified by enrollment duration: 6-9 months (n=663), 9-12 months (n=420), and ≥12 months (n=288). Intervention included monthly CGM data reviews and clinician-led treatment adjustments. Clinical status was categorized via GRI Zones. Primary endpoints were ‘Zone Improvement’ for individuals who entered the program in higher-risk zones (Baseline Zones C-E) and duration-response efficacy. Significance was assessed via Wilcoxon signed-rank and Kruskal-Wallis tests.Results: Individuals in higher-risk zones achieved significant GRI improvement (p<0.0001) across all cohorts. A significant duration-response relationship existed (p=0.028): mean improvement increased from +0.69 zones (6-9 months) to +1.09 zones (≥12 months). Those enrolled ≥12 months were significantly more likely to convert to Low Risk (Zones A/B) than those at 6-9 months (55.3% vs. 34.2%; Relative Risk [RR] 1.62, 95% CI 1.23-2.13). The 12-month NNT was 4.7. Among the ≥12-month cohort entering in Zones A/B, 83% maintained low-risk status.Conclusion: Use of the GRI standard in a RPM program is associated with improved glycemic quality over time in clinical practice.
A. Fredman: Employee; Current; SweetSpot. D. Klonoff: Advisory Panel; Current; Afon Technology, Atropos Health, Embecta, Glooko, Inc., Glucotrack, Lifecare, Inc. Advisory Panel; Ended; Novo Nordisk. Advisory Panel; Current; Sanofi, Synchneuro, Thirdwayv Inc. R. Oiknine: Employee; Current; SweetSpot.
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