3 abstracts, svenska presentatörer, och som var föreläsningar på EASD

Inskickat till www red av Marcus Lind

 

 

• Association of CGM metrics with future risk of micro- and macrovascular complications in

type 1 diabetest

 

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:

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.

 

_____________________________________

 

 

• Cardiovascular effectiveness of GLP-1 receptor agonists beyond cardiovascular outcome

trial populations: a nationwide target trial emulation in the Swedish National Diabetes Register trial populations: 

 

 

J. MichelsenJ. Michelsen1, S. Hallström2, H. Imberg1, V. Tasselius1, A. Norhammar3, T. Nyström3, M. Lind1,2, The REDDIE Consortium;

1University of Gothenburg, Gothenburg, Sweden,2Sahlgrenska University Hospital, Gothenburg, Sweden, 3Karolinska Institute,

Stockholm, Sweden.

 

 

Background and aims:

Cardiovascular outcome trials for glucagon-like peptide-1 receptor agonists (GLP-1RA) typically enrol high-risk

patients and exclude many real-world users.

 

To address this gap, we evaluated the cardiovascular effectiveness of sustained GLP-1 RA

use versus dipeptidyl peptidase-4 inhibitors (DPP-4i) in a population, derived from nationwide Swedish registries, consisting of

individuals with type 2 diabetes (T2D) generally excluded in trials. This cohort mainly consists of persons with low cardiovascular risks,

or comorbidities and complications that might normally limit long-term efficacy evaluation in clinical trials.

 

 

Materials and methods:

We emulated a target trial using a new-user, active-comparator design. Eligible participants were adults with

T2D initiating either drug class during 2012-2022, with sufficient baseline data on clinical risk factors, comorbidities, and medications

for confounder adjustment, and not meeting emulated LEADER trial eligibility.

 

The primary endpoint was a composite of myocardial infarction, stroke, hospitalisation for heart failure and cardiovascular mortality at 3.5 years of follow-up. Secondary endpoints

included individual components and all-cause mortality. Longitudinal Targeted Minimum-Loss Estimation (LTMLE) adjusted for time-

dependent confounders and treatment patterns when estimating cumulative risk differences and risk ratios under sustained use with

GLP-1 RA versus DPP-4i.

 

Results:

The study included 85,004 individuals, of which 29,506 initiated treatments with GLP-1 RA and 55,498 with DPP-4i. The mean

age at inclusion was 59 years (SD 12) for those initiating GLP-1 RA and 66 years (SD 12) for those initiating DPP4-i. For GLP1-RA and

DPP-4i initiators,16,868 (57%) and 32,334 (58%) patients were male, respectively. The median follow-up time was 4.0 years (IQR 1.9 to

6.2).

 

The cumulative incidence of the composite primary endpoint was lower with sustained GLP-1 RA versus DPP-4i treatment 6.2%

(95% CI 5.8 to 6.7) versus 7.0% (95% CI 6.7 to 7.3), with a risk ratio of 0.89 (95% CI 0.82 to 0.97; p = 0.006). Significant reductions were

observed for heart failure (0.75; 95 % CI 0.67 to 0.84), cardiovascular mortality (0.69; 95% CI 0.58 to 0.82) and stroke (0.87; 95% CI 0.77

to 0.99), while the effect on myocardial infarction was non-significant (0.96; 95% CI 0.83 to 1.11).

 

Overall mortality was also lower with GLP-1 RAs (0.64; 95% CI 0.59 to 0.70).

 

Conclusion:

Our results indicate that the cardiovascular and mortality benefits of GLP-1 RA extend beyond those eligible for inclusion

in cardiovascular outcome trials to the broader population of people with T2D including those with lower cardiovascular risks or

comorbidities and complications typically excluded from cardiovascular outcome trials. Accordingly, GLP-1 RA should be considered a

first-line option for therapy also in the broader population.

 

Clinical Trial Registration Number:

N/A

 

Supported by:

EU-funded (European Commission, Horizon Europe, Grant Agreement 101095556)

 

Disclosure: J

. Michelsen:J. Michelsen: None.

 

__________________________________________

 

 

• Effects of automated insulin delivery in routine clinical practice over 4 years: a nationwide

evaluation using the Swedish National Diabetes Register 

R. SinghR. Singh1, H. Imberg1, S. Hallström1, P. Adolfsson1, J. Jendle2, M. Lind1;

 

1Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Institute of Medicine, Gothenburg,

Sweden, 2Örebro University, Örebro, Sweden.

 

 

Background and aims:

Automated insulin delivery (AID) systems have demonstrated significant benefits for glucose regulation in

individuals with type 1 diabetes (T1D) in both randomised trials and observational studies.

 

However, long-term, population-based real-world evaluations including both HbA1c and continuous glucose monitoring (CGM) data remain limited. The aim of this study was

to assess the effect of AID on glucose control over four years in adults with T1D treated in routine clinical practice.

 

 

Materials and methods:

Adults with T1D recorded in the Swedish National Diabetes Register (NDR) who initiated an AID system

between 1 January 2019 and 31 December 2024 were eligible for inclusion.

 

Each AID user was matched on age, sex, and index year to two controls treated with multiple daily injections (MDI) in combination with CGM. Individuals with prior use of sensor-augmented

pump (SAP) therapy were excluded from the main analysis but included in sensitivity analyses. All participants were followed until 31

December 2025. Longitudinal targeted maximum likelihood estimation (LTMLE) was used to estimate the average treatment effect

under sustained AID versus MDI+CGM treatment, adjusting for age, sex, diabetes duration, education level, BMI, smoking status,

diabetes complications, and baseline glucose metrics.

 

 

Results

A total of 1,117 adults initiating AID and 2,234 matched controls treated with MDI+CGM were included. AID use was associated

with consistently improved glycaemic outcomes, with significant HbA1c reductions at each annual follow-up and an adjusted mean

difference of −6.2 mmol/mol (95% CI −8.6 to −3.8; p<0.001) compared with MDI+CGM after four years of follow-up (Figure 1). Time in

range increased by 7.4, 11.0, 10.5, and 9.1 percentage points at years 1-4, respectively (all p<0.001), and time below range decreased

by 1.5, 2.2, 2.1, and 2.1 percentage points at years 1-4, respectively (all p<0.001) with AID compared with MDI+CGM. Sensitivity analyses

including all AID users regardless of prior SAP use (n=2,456) yielded consistent findings.

 

 

Conclusion:

In this population-based study, adults with T1D who initiated AID achieved better glycaemic control over four years than

those continuing MDI therapy.

 

These findings support previously reported benefits of AID and reinforce its continued implementation

in routine clinical practice.

 

 

Clinical Trial Registration

Number: N/A

 

 

Supported by:

The Strategic Healthcare Committee, Region Västra Götaland”

 

 

Disclosure:

R. Singh:R. Singh: None.

 

 

 

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