Key result
Hybrid closed-loop systems and SGLT2i are linked to superior myocardial and vascular improvements over MDI.
Why the study?
Hybrid closed-loop systems are the gold standard for glycemic management in type 1 diabetes, but their effects on vascular and myocardial function compared with multiple daily injections or SGLT-2 inhibitors remain unclear.
Do hybrid closed-loop systems or SGLT-2 inhibitors added to multiple daily injections improve glycemic control, vascular function, and myocardial deformation compared with intensification of multiple daily injections in patients with poorly controlled type 1 diabetes?
Observational (n=90)
Do hybrid closed-loop systems or SGLT-2 inhibitors added to multiple daily injections improve glycemic control, vascular function, and myocardial deformation compared with intensification of multiple daily injections in patients with poorly controlled type 1 diabetes?
In patients with poorly controlled type 1 diabetes, both hybrid closed-loop systems and SGLT2 inhibitors demonstrated superior improvements in glycemic control, myocardial deformation, and vascular function over 12 months compared to intensification of multiple daily insulin injections.
May increase TIR with hybrid closed-loop systems in T1D; hypothesis-generating for vascular benefits in larger trials.
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 Hybrid closed-loop systems improve vascular and myocardial function compared with multiple daily injections (MDIs) or sodium glucose cotransporter 2 inhibitors (SGLT-2is) in T1D. Methods Ninety consecutive patients with poorly controlled T1D under MDI treatment were categorized into three groups according to the treatment approach: (1) Hybrid closed-loop systems 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 by assessing time in normal glucoses range (TIR), (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, (4) global longitudinal strain (GLS), by speckle tracking echocardiography, (5) coronary flow reserve after adenosine infusion, by Doppler echocardiography, (6) flow mediated dilatation of brachial artery, as a marker of endothelial function. Results At 6 months, Hybrid closed-loop systems (demonstrated the most significant increase in time in normal glucose range followed by SGLT-2i (+28.61 vs +10.91, P = 0.026) compared with multiple daily injections group (+2.11, P < 0.001 for all comparisons). At 12 months, patients on Hybrid closed-loop systems showed a 2-fold and a 4-fold higher increase in time in range compared with SGLT-2i (P = 0.026) and multiple daily injections group (P <0.001), respectively. At 12 months, Hybrid closed-loop systems 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 multiple daily injections (+5.67%, +1.49%, and +1.99%, respectively; P<0.05). At 12 months, Hybrid closed-loop systems and SGLT-2i group displayed the most significant improvement in GLS (6.7 % and 4 %), CFR (6.3 % and 4.2%), and FMD (11.2% and 8.3%) compared with multiple daily injections (2.2 %, +2.6 %, and +3.5 %, respectively; P< 0.05).The absolute change of GLS, CFR, PWV, PBR, and cSBP was associated with the absolute change of TIR (P <0.05). Conclusions Hybrid closed-loop systems and SGLT2i demonstrated superiority over multiple daily injections in terms of glycemic control and cardiovascular function in T1D. a population whose cardiovascular burden is often underrecognized in clinical practice.myocardial and vascular parameters
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Ikonomidis et al. (2026) conducted an observational in Poorly controlled type 1 diabetes (n=90). Hybrid closed-loop systems or SGLT-2i added to multiple daily injections vs. Intensification of multiple daily injections (MDI) was evaluated on Vascular and myocardial function markers (including PWV, cSBP, PBR, GLS, CFR, FMD) and time in normal glucose range (TIR) (p=<0.05). Hybrid closed-loop systems and SGLT-2i significantly improved GLS (6.7% and 4% vs 2.2%) and reduced PWV (-15.71% and -10.14% vs +5.67%; P<0.05) vs MDI at 12 months.
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