Effects of hybrid closed-loop systems and SGLT2i on myocardial deformation and vascular function in type 1 diabetics

Objective

Patients with type 1 diabetes (T1D) present early subclinical signs of vascular and endothelial dysfunction. Hybrid closed-loop systems (HCLSs) are the gold standard for glycemic management; however, their cardiovascular benefits remain unclear.

The aim of this study is to determine whether Hybrid closed-loop systems improve vascular and myocardial function compared with multiple daily injections (MDIs) or sodium glucose cotransporter 2 inhibitors (SGLT-2is) in T1D.

Methods

Ninety consecutive patients with poorly controlled T1D under MDI treatment were categorized into three groups according to the treatment approach:

(1) Hybrid closed-loop systems or (2) SGLT-2i added to MDI or (3) intensification of MDI treatment.

We assessed at baseline and 6 and 12 months posttreatment: (1) continuous glucose monitoring metrics by assessing time in normal glucoses range (TIR), (2) pulse wave velocity (PWV) and central systolic blood pressure (cSBP) and central diastolic blood pressure (cDBP) as markers of vascular function, and (3) the perfused boundary region (PBR) of the sublingual arterial microvessels, as a marker of endothelial glycocalyx integrity, (4) global longitudinal strain (GLS), by speckle tracking echocardiography, (5) coronary flow reserve after adenosine infusion, by Doppler echocardiography, (6) flow mediated dilatation of brachial artery, as a marker of endothelial function.

Results

At 6 months, Hybrid closed-loop systems (demonstrated the most significant increase in time in normal glucose range followed by SGLT-2i (+28.61 vs +10.91, P = 0.026) compared with multiple daily injections group (+2.11, P < 0.001 for all comparisons). At 12 months, patients on Hybrid closed-loop systems showed a 2-fold and a 4-fold higher increase in time in range compared with SGLT-2i (P = 0.026) and multiple daily injections group (P <0.001), respectively. At 12 months, Hybrid closed-loop systems and SGLT-2i group displayed the most significant decrease in PWV (-15.71% and -10.14%), cSBP (-8.15% and -6.88%), and PBR (-6.98% and -8.98%) compared with multiple daily injections (+5.67%, +1.49%, and +1.99%, respectively; P<0.05). At 12 months, Hybrid closed-loop systems and SGLT-2i group displayed the most significant improvement in GLS (6.7 % and 4 %), CFR (6.3 % and 4.2%), and FMD (11.2% and 8.3%) compared with multiple daily injections (2.2 %, +2.6 %, and +3.5 %, respectively; P< 0.05).The absolute change of GLS, CFR, PWV, PBR, and cSBP was associated with the absolute change of TIR (P <0.05).

Conclusions

Hybrid closed-loop systems and SGLT2i demonstrated superiority over multiple daily injections in terms of glycemic control and cardiovascular function in T1D. a population whose cardiovascular burden is often underrecognized in clinical practice.myocardial and vascular parameters