In a cross-sectional study of 611 adults with type 1 diabetes using 90 days of continuous glucose monitoring (CGM), researchers examined why glucose management indicator (GMI) and laboratory HbA1c can diverge. Frequent glucose excursions that were both high in amplitude and prolonged, particularly excursions peaking with at least 250 mg/dL with a time to peak of at least 90 minutes, were independently associated with higher GMI relative to HbA1c across CGM systems and HbA1c categories. In contrast, coefficient of variation, a commonly used measure of glycemic variability, showed weaker and less consistent associations with GMI-HbA1c discordance.

The findings suggest that CGM may reveal clinically relevant glucose patterns that HbA1c can average out over time. After accounting for excursion burden, GMI and updated GMI showed stronger relationships with albuminuria than HbA1c in the overall cohort, while their ability to identify a high triglyceride-glucose index was greater among patients with the highest excursion burden. However, adding excursion measures as independent predictors did not consistently improve predictive performance, suggesting that excursion structure may be most useful for interpreting GMI rather than serving as a standalone risk marker. Because the study was cross-sectional and conducted at a single tertiary center, the findings do not establish causality and require validation in broader populations.

Reference: Park S, Cho SH, Kim S, et al. High-Amplitude and Prolonged Glucose Excursions as a Key Determinant of Discordance Between Glucose Management Indicator and Glycated Hemoglobin in Type 1 Diabetes. Diabetes Care. 2026 Jul 1;49(7):1221-1230. doi: 10.2337/dc25-2820.

In a retrospective study of 393 hospitalized adults with poorly controlled type 2 diabetes (T2D) initiating insulin pump therapy plus continuous glucose monitoring, researchers evaluated whether insulin-resistance markers could predict how quickly patients achieved glycemic stability, defined as time in range greater than 70% for 24 consecutive hours. Median time to stability was 4 days. Older age, higher HbA1c, higher fasting insulin, and a higher triglyceride-glucose (TyG) index were independently associated with a longer time to glycemic stability. Homeostasis model assessment of insulin resistance, body mass index, fasting glucose, and other metabolic measures were not independently predictive in the multivariable model.

Using those four predictors, the investigators developed and internally validated a nomogram that outperformed a model based only on age and HbA1c. Patients classified as high risk required a median of 4 days to reach stability versus 2 days for those at low risk. The TyG index—calculated from routine fasting triglyceride and glucose measurements—emerged as the strongest independent metabolic predictor, suggesting it may help capture insulin resistance and metabolic dysfunction relevant to short-term treatment response. However, the study was exploratory, retrospective, and conducted at a single center in patients with severe uncontrolled T2D. The model is not yet ready for routine clinical use and requires prospective, external validation before it can guide inpatient management.

Reference: Ke Y, Shi S, Zhou N, et al. Predicting time to glycemic stability in hospitalized type 2 diabetes patients using insulin resistance indices: a nomogram development and validation study. Endocr Connect. 2026 May 1;15(5):e260111. doi: 10.1530/EC-26-0111. 

Researchers of a study of 100 adults—50 with newly diagnosed type 2 diabetes (T2D) and 50 age-, sex-, and body mass index-matched participants with normal glucose tolerance—examined how liver fat relates to glucagon secretion early in T2D. Compared with the normal-glucose-tolerance group, participants with T2D had approximately 65% higher hepatic lipid content, 30% higher fasting glucagon, and 75% higher early postprandial glucagon concentrations. metabolic dysfunction-associated steatotic liver disease (MASLD), rather than T2D itself, was associated with higher fasting glucagon, while postprandial glucagon was related to hepatic lipid content specifically among participants with T2D.

Notably, individuals with both MASLD and T2D had approximately 47% higher early postprandial glucagon concentrations, an association that was independent of insulin sensitivity and visceral adipose tissue volume. Contrary to the researchers’ hypothesis, circulating amino acids and nonesterified fatty acids did not mediate these relationships. The findings point to an early connection between hepatic fat and altered glucagon regulation in T2D. They also raise questions about whether this liver-glucagon relationship could eventually help inform treatment strategies, particularly as therapies targeting glucagon signaling continue to emerge.

Reference: Koutnik-Fotopoulos E. MASLD in Early T2D Tied to 47% Higher Early Postprandial Glucagonemia. Physicians Weekly. Published June 2, 2026. Accessed August 26, 2026. https://www.physiciansweekly.com/post/masld-in-early-t2d-tied-to-47-higher-early-postprandial-glucagonemia