Association of Time in Range and Time in Tight Range With Cardiovascular Risk Factor Exposure in Youth With Type 1 Diabetes: A Cross‐Sectional Analysis on LDL Cholesterol and Blood Pressure Data From the SWEET International Database

Aims To test the hypothesis that continuous glucose monitoring (CGM) metrics are independently associated with cardiovascular risk factor (CVRF) exposure, particularly low‐density lipoprotein cholesterol (LDL‐C) and blood pressure (BP), in youth with type 1 diabetes (T1D) enrolled in the international SWEET registry. Materials and Methods This cross‐sectional study included youth aged 6–18 years with T1D duration ≥ 1 year, not receiving antihypertensive or lipid‐lowering therapy and with available CGM profiles (≥ 14 days), lipid and BP data between January 2019 and June 2023. Associations between CGM metrics and LDL‐C or BP were analysed using multiple linear regression, adjusted for sex and pubertal status (model 1) and additionally for body mass index–SDS (model 2), diabetes duration (model 3) and HbA1c (model 4). Results Data from 3328 subjects (median age 14.3 years, T1D duration 5.6 years, 52.2% male) were analysed. Time in range (TIR) and time in tight range (TITR) were inversely associated with BP‐SDS and LDL‐C, while time above range (TAR), mean glucose, glucose variability (coefficient of variation (CV)) [%] and glycemia risk index showed positive associations (all p < 0.01). In multivariable regression models 1–3, TIR, TITR, TAR and glycemia risk index remained independently associated with LDL‐C and systolic BP‐SDS ( p < 0.001), with CV also independently associated with systolic BP‐SDS ( p < 0.001). In model 4 associations with SBP‐SDS were attenuated, whereas those with LDL‐C remained significant, although with a reversal direction. Conclusions Key CGM metrics, particularly TIR and TITR, are independently associated with LDL‐C and BP in youth with T1D, highlighting their potential clinical relevance in the assessment of cardiovascular risk profile, alongside HbA1c.