Endocrine Abstracts

JOINT2066

Aim: To investigate early indicators of cardiovascular disease (CVD) in youths with type 1 diabetes mellitus (T1DM), focusing on pulse wave velocity (cfPWV) and augmentation index (AIx@75) and their associations with various glycemic parameters and new metrics derived from continuous glucose monitoring (CGM) systems.

Patients and Methods: The study had two parts: for the cross-sectional part, 124 youths with T1DM (58 boys, mean age: 10. 75 ± 3. 57 years and mean disease duration: 3. 09 ± 2. 91years) were assessed, whereas for the longitudinal part, 87 patients (44 boys, mean age 10. 72 ± 3. 35 years and mean disease duration: 3. 27 ± 2. 84 years at the first assessment), completed 3 visits with a six month interval. In each visit, cfPWV and AIx@75 were quantified using a validated non – invasive method, while glycemic parameters such as HbA1c, time in range (TIR), time above range (TAR) and time below range (TBR) were assessed during the last 3 months from the assessment. For the longitudinal part patients were divided in 2 groups: TIR improvers: patients with constantly TIR≥ 70% or constantly TIR ≥ 60% and improved by + ≥ 10% from the beginning of the study vs TIR non-improvers and HbA1c improvers: patients with constantly HbA1c ≤ 7% or constantly HbA1c ≤ 8% and improved by -≥0. 8% from the beginning vs HbA1c non-improvers. Univariate and multivariate linear regression were used to explore the association of cfPWV and AIx@75 with glycemic variables.

Results: In the cross-sectional study all arterial stiffness parameters were significantly correlated with systolic and diastolic blood pressure (SBP, DBP), whereas AIx@75 was negatively correlated with TIR (r = - 0. 190, P = 0. 034) and positively correlated with TAR (r = 0. 212, P = 0. 018). In the longitudinal study, TIR improvers had lower PWV values (P = 0. 013) at the 3^rd assessment compared to TIR non-improvers and showed significant improvement in ΔPWV Z score according to age (P = 0. 022) and ΔSBPindex (P = 0. 036). Finally, no significant difference regarding arterial stiffness parameters was shown between HbA1c improvers and HbA1c non-improvers.

Conclusion: Higher Alx@75 values were significantly correlated to lower TIR and higher TAR values. Children and adolescents who had TIR in the suggested target or improved their TIR, showed significantly lower PWV values in their final assessment and significantly improved both PWV and SBP. Such a finding was not shown when HbA1c was used as a metric of glycemia, indicating TIR as a more sensitive index for CVD.