Association of Time in Range and Time in Tight Range With Cardiovascular Risk Factor Exposure in Youth With Type 1 Diabetes: A Cross-Sectional Analysis on LDL Cholesterol and Blood Pressure Data From the SWEET International Database.

AIMS: To test the hypothesis that continuous glucose monitoring (CGM) metrics are independently associated with cardiovascular risk factor (CVRF) exposure, particularly low-density lipoprotein cholesterol (LDL-C) and blood pressure (BP), in youth with type 1 diabetes (T1D) enrolled in the international SWEET registry.

MATERIALS AND

METHODS

This cross-sectional study included youth aged 6-18 years with T1D duration ≥ 1 year, not receiving antihypertensive or lipid-lowering therapy and with available CGM profiles (≥ 14 days), lipid and BP data between January 2019 and June 2023. Associations between CGM metrics and LDL-C or BP were analysed using multiple linear regression, adjusted for sex and pubertal status (model 1) and additionally for body mass index-SDS (model 2), diabetes duration (model 3) and HbA1c (model 4).

RESULTS

Data from 3328 subjects (median age 14.3 years, T1D duration 5.6 years, 52.2% male) were analysed. Time in range (TIR) and time in tight range (TITR) were inversely associated with BP-SDS and LDL-C, while time above range (TAR), mean glucose, glucose variability (coefficient of variation (CV)) [%] and glycemia risk index showed positive associations (all p < 0.01). In multivariable regression models 1-3, TIR, TITR, TAR and glycemia risk index remained independently associated with LDL-C and systolic BP-SDS (p < 0.001), with CV also independently associated with systolic BP-SDS (p < 0.001). In model 4 associations with SBP-SDS were attenuated, whereas those with LDL-C remained significant, although with a reversal direction.

CONCLUSIONS

Key CGM metrics, particularly TIR and TITR, are independently associated with LDL-C and BP in youth with T1D, highlighting their potential clinical relevance in the assessment of cardiovascular risk profile, alongside HbA1c.