Clinical and socioeconomic determinants of glycaemic control derived from continuous glucose monitoring in adults with type 1 diabetes.

AIM: To identify clinical, sociodemographic and glucometric factors associated with achieving international glycaemic targets derived from intermittently scanned continuous glucose monitoring (isCGM) in adults with type 1 diabetes mellitus (T1DM) treated with multiple daily injections (MDI) in Andalusia, a region with universal access to isCGM.

METHODS

A cross-sectional, population-based study was conducted using centralized electronic health records from the Andalusian Public Health System (APHS). Adults with T1DM using isCGM for ≥1 year and integrated glucometric data in Electronic Health Records in APHS in the 14 days preceding the download were included. Four glycaemic endpoints were evaluated: time in range (TIR ≥ 70%), time above range (TAR < 25%), time below range (TBR < 5%), and achievement of full AGP profile. Univariate analyses and multivariable logistic regression models were used to identify independent predictors.

RESULTS

A total of 7,885 individuals were included. Overall, 24.8% achieved TIR ≥ 70%, 35.0% TAR < 25%, 72.9% TBR < 5%, and 12.3% met the full AGP profile. Lower HbA1c, lower glycaemic variability and a higher number of daily scans were consistently associated with achieving glycaemic targets. Older age and male sex were independent predictors of TIR ≥ 70%. Socioeconomic status showed a significant association: individuals in the intermediate-income group had higher odds of achieving TIR, TAR and full AGP criteria. No socioeconomic associations were observed for TBR < 5%.

CONCLUSIONS

In a real-world setting with universal isCGM provision, clinical, sociodemographic and glucometric determinants independently influence the achievement of glycaemic targets in adults with T1DM. Integrating advanced monitoring metrics with explicit consideration of social determinants may enhance the precision and equity of glycaemic management strategies.