Glycemic Variability and Time in Range Are Associated with the Risk of Overweight and High LDL-Cholesterol in Children and Youths with Type 1 Diabetes

Introduction: Reducing cardiovascular risk factors (CVRFs) exposure in children and youths with type 1 diabetes (T1D) is critical for cardiovascular disease (CVD) prevention. Long-term exposure to hyperglycemia, measured by HbA1c, had been recognized as the main factor affecting the CVRFs profile. To date, the possible association between short-term glycemic control and variability measured by continuous glucose monitoring (CGM) metrics and CVRFs has not been explored. The aim of this study was to test the hypothesis that CGM metrics independently contribute to CVRF exposure in children and youths with T1D. Method: BMI, blood pressure (BP), lipid profile, and CGM data of 895 children and youths with T1D were analyzed. Binary multivariable logistic regression analyses were performed to test independent associations between CVRFs (BMI >85th percentile, LDL-c>100 mg/dL, BP >90th percentile) and CGM metrics according to sex and adjusting for confounding factors. Results: In both sexes, metrics of hypoglycemia and glycemic variabilities (coefficient of variation [%CV]) positively correlated with BMI percentile. LDL-c positively correlated with mean glucose and metrics of hyperglycemia. A negative correlation was found between LDL-c and time in range (TIR). No significant correlations were found between CGM metrics and BP percentiles. In both sexes, TIR <70% was significantly associated with LDL-c>100 mg/dL (OR 3.2 in males, 2.1 in females). In females, CV >36% was significantly associated with overweight (OR 2.1). Conclusions: CGM metrics of glycemic control and variability were significantly associated with the risk of overweight in females and high LDL-c in both sexes.