MiniMed TM 780G Hybrid Closed-Loop Systems Improves Markers of Vascular and Endothelial Function in Patients with Type 1 Diabetes: Association with Continuous Glucose Monitoring Metrics

Abstract

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 HCLS improves vascular and endothelial function compared with multiple daily injections (MDIs) or sodium glucose cotransporter 2 inhibitors (SGLT-2is) in T1D.

Research Design and Methods:

Ninety consecutive patients with poorly controlled T1D under MDI treatment were categorized into three groups according to the treatment approach: (1) HCLS 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, (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.

Results:

At 6 months, HCLS demonstrated the most significant increase in time in range (TIR) followed by SGLT-2i (+28.61 vs +10.91, P = 0.026) compared with MDI group (+2.11, P < 0.001 for all comparisons). At 12 months, patients on HCLS showed a 2-fold and a 4-fold higher increase in TIR compared with SGLT-2i (P = 0.026) and MDI group (P < 0.001), respectively. At 12 months, HCLS 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 MDI (+5.67%, +1.49%, and +1.99%, respectively; P < 0.05). The absolute change of PWV, PBR, and cSBP was associated with the absolute change of TIR (P < 0.05).

Conclusions:

MiniMed^TM 780G HCLS demonstrated superiority over MDI or SGLT-2i in terms of glycemic control and cardiovascular function in T1D. These results support HCLS as a preferred therapeutic option for the prevention of cardiometabolic disease in individuals with T1D, in a population whose cardiovascular burden is often underrecognized in both research and clinical practice.