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Association of CGM metrics with future risk of micro- and macrovascular complications in diabetes type 1 diabetes
P. FatullaP. Fatulla1, H. Imberg1, R. Holman2, P. Adolfsson1, C. Wang3, S. Hallström4, T. Nyström5, M. Lind1;

1University of Gothenburg, Gothenburg, Sweden,2University of Oxford, Oxford, UK, 3Statistiska Konsultgruppen, Gothenburg, Sweden,
4Sahlgrenska University Hospital, Gothenburg, Sweden, 5Karolinska Institutet, Stockholm, Sweden.

Background and aims:

Continuous glucose monitoring (CGM) has become central to assessing glucose control in type 1 diabetes (T1D),
yet the relationship between CGM-derived metrics and long-term complications remains insufficiently characterized in large,
population-based cohorts. Our study evaluated whether key CGM metrics were associated with micro- and macrovascular
complications in individuals with T1D.

Materials and methods:

We included children and adults with T1D from the Swedish National Diabetes Register with CGM
measurement between 17th May 2018 to 31st December 2024 and followed up to 31st December 2025.

Time in range (TIR), mean glucose (MG), glucose coefficient of variation (CV), time below range (TBR) and HbA1c were analysed in Cox proportional hazards
models as time-updated mean values to evaluate associations with incident retinopathy, albuminuria, amputation, and
cardiovascular disease.

Adjusted hazard ratios (HRadj) were expressed as risk gradients per 1 standard deviation (SD) for each
glycaemic metric, adjusted for age, sex, index year, diabetes duration, smoking status, BMI, LDL, HDL, eGFR, and blood pressure.
Analyses of TBR were additionally adjusted for time-updated MG.

Results:Results:

Across outcome-specific cohorts, excluding individuals with prior events, 17,186-47,613 participants were included, with a
mean follow-up of 4,1-4.7 years. Mean age ranged from 25.8 to 37.6 years (SD 14.9-19.9). All CGM metrics showed strong and consistent
associations with both micro- and macrovascular complications, comparable in magnitude to HbA1c (TableTable). TBR was consistently
associated with higher risk of complications.

Conclusion:

Higher TIR and lower MG are strongly associated with reduced risks of micro- and macrovascular complications,
supporting their use in clinical practice and potential surrogate endpoints in clinical trials.

The consistent association between TBR and complications highlights the importance of minimising hypoglycaemia to reduce their risk in individuals with T1D.

Clinical Trial Registration Number: N/A

Supported by: Västra Götaland Region; ALF agreement (ALFGBG-1006886); Swedish Childhood Diabetes Foundation

Disclosure: P. Fatulla:P. Fatulla: None.

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