Time in range, time in tight range, glycemia risk index and other key continuous glucose monitoring metrics are associated with cardiovascular risk factors exposure in children and adolescents with type 1 diabetes: data from the sweet international database

Abstract

Introduction: Cardiovascular risk factors (CVRFs) such as hypertension, obesity and dyslipidemia are the main risk factors for developing chronic complications in people with type 1 diabetes (T1D). Not many studies have assessed the association of CVRFs and continuous glucose monitoring (CGM) metrics. Objectives: The main aim of this study was to examine the association between CVRF’s and CGM metrics in a large international cohort of children and adolescents with T1D from the SWEET registry to test the hypothesis that CGM metrics independently contribute to CVRFs exposure. Methods: This cross-sectional study included participants with T1D duration≥1 year, aged 6-18 years, who had a documented 2-week CGM with >70% completeness and CVRFs (lipids, Body Mass Index-BMI and blood pressure-BP) data from January 2019–June 2023. Linear regression models were applied to test the independent association between CGM metrics and CVRFs, adjusting for confounding factors (age, diabetes duration, gender, insulin treatment, CGM modalities groups and BMI SDS, except for the model run with BMI SDS as output variable). Results: Data from 3,107 children and adolescents with T1D (median age 14.30 yrs, median T1D duration 7.37 yrs, 51.5%males) were analysed. Linear regression showed that Time In Range (TIR), Time In Tight Range (TITR), Glycemia Risk Index (GRI), and the other key CGM metrics were significantly associated with CVRFs (Table 1). In particular, TIR, TITR, Time above range, GRI, and GRI hyperglycemia component were significant independent predictors of BMI-SDS, systolic BP-SDS, LDL cholesterol and triglycerides (TG). The coefficient of variation was a significant predictor of TG. Time Below Range (TBR) and GRI hypoglycemia component were significant predictors of BMI-SDS and HDL cholesterol. TBR was also a significant predictor of LDL cholesterol. Conclusions: In children and adolescents with T1D, TIR, TITR, GRI and the other key CGM metrics significantly contribute to CVRFs exposure.