Abstract:
Background: Diabetes technologies, including continuous glucose monitoring (CGM), insulin pumps and hybrid closed loop (HCL) systems, have transformed the management of type 1 diabetes mellitus (T1DM) by improving glycaemic control, increasing time in range and reducing hypoglycaemia. A recent systematic review demonstrated consistent improvements in these glycaemic outcomes with diabetes technology; however, evidence demonstrating a reduction in cardiovascular endpoints, including acute coronary syndrome, stroke and peripheral arterial disease, remains limited. We therefore aimed to investigate the association between diabetes technology use and prevalent macrovascular disease in adults with T1DM attending a tertiary diabetes service.
Methods: A retrospective cross-sectional study was conducted including 325 adults with T1DM attending a specialist diabetes service. Demographic data, HbA1c, diabetes technology use and previous macrovascular disease (acute coronary syndrome, stroke and peripheral arterial disease) were collected from electronic health records – specifically focusing on keywords such as ‘’ischaemic heart disease, ischaemic cardiomyopathy, transient ischaemic attacks, stroke, peripheral arterial disease’’. Univariable analyses were performed using chi-square and independent-samples t-tests via the SPSS software. Multivariable logistic regression was used to assess the association between diabetes technology use and prevalent macrovascular disease after adjustment for age, gender and HbA1c.
Results: Overall, 202/325 (62.2%) patients were using diabetes technology and 39/325 (12.0%) had established macrovascular disease. Technology use was not associated with prevalent macrovascular disease on univariable analysis (13.9% vs 8.9%, p=0.186). In multivariable logistic regression, increasing age was independently associated with macrovascular disease (adjusted OR 1.12, 95% CI 1.08–1.17, p<0.001). HbA1c demonstrated a non-significant trend towards increased odds of macrovascular disease (adjusted OR 1.03, 95% CI 1.00–1.06, p=0.059). Diabetes technology use was not independently associated with prevalent macrovascular disease (adjusted OR 1.98, 95% CI 0.68–5.72, p=0.210).
Conclusions: In this cross-sectional cohort of adults with T1DM, diabetes technology use was not independently associated with prevalent macrovascular disease after adjustment for age, sex and HbA1c. Increasing age remained the strongest independent predictor of macrovascular disease. These findings suggest that optimisation of glycaemic control alone may be insufficient to reduce macrovascular disease burden and reinforce the importance of a comprehensive cardiovascular risk reduction strategy, including optimisation of blood pressure, lipid management, renal protection, smoking cessation, lifestyle modification and patient education. Prospective longitudinal studies incorporating diabetes duration and timing of technology initiation are required to determine whether diabetes technologies influence future cardiovascular risk.
