Continuous Glucose Monitor, Insulin Pump, and Automated Insulin Delivery Therapies for Type 1 Diabetes: An Update on Potential for Cardiovascular Benefits

Abstract

Purpose of Review The incidence of type 1 diabetes (T1D) is rising in all age groups. T1D is associated with chronic microvascular and macrovascular complications but improving glycemic trends can delay the onset and slow the progression of these complications. Utilization of technological devices for diabetes management, such as continuous glucose monitors (CGM) and insulin pumps, is increasing, and these devices are associated with improvements in glycemic trends. Thus, device use may be associated with long-term prevention of T1D complications, yet few studies have investigated the direct impacts of devices on chronic complications in T1D. This review will describe common diabetes devices and combination systems, as well as review relationships between device use and cardiovascular outcomes in T1D. Recent Findings Findings from existing cohort and national registry studies suggest that pump use may aid in improving cardiovascular risk factors such as hypertension and dyslipidemia. Furthermore, pump users have been shown to have lower arterial stiffness and better measures of myocardial function. In registry and case–control longitudinal data, pump use has been associated with fewer cardiovascular events and reduction of cardiovascular disease (CVD) and all-cause mortality. Summary CVD is the leading cause of morbidity and mortality in T1D. Consistent use of diabetes devices may protect against the development and progression of macrovascular complications such as CVD through improvement in glycemic trends. Existing literature is limited, but findings suggest that pump use may reduce acute cardiovascular risk factors as well as chronic cardiovascular complications and overall mortality in T1D.

Higher glucose fluctuation is associated with a higher risk of cardiovascular disease: Insights from pooled results among patients with diabetes

“… 30 Meanwhile, a higher glucose fluctuation was more likely to occur among type 1 diabetes because of the absolute insulin deficiency and inappropriate use of hypoglycemic drugs. 31 , 32 Moreover, Shen et al 4 also highlighted that hypoglycemia played a significant mediating role between HbA1c variability and the incidence of CVD. Similarly, our subgroup analysis for per HbA1c‐SD showed that the risk of CVD was significantly higher among patients with type 1 diabetes than those with type 2 diabetes, which might be attributed to a vulnerably worse glycemia control, a high incidence of hypoglycemia, and the functional loss of islet cells among type 1 diabetes.…”

“…This result suggested that hypoglycemia might not be effectively controlled for patients with type 1 diabetes, which facilitated worse glycemia control, ultimately leading to an increased risk of CVD 30 . Meanwhile, a higher glucose fluctuation was more likely to occur among type 1 diabetes because of the absolute insulin deficiency and inappropriate use of hypoglycemic drugs 31,32 . Moreover, Shen et al 4 also highlighted that hypoglycemia played a significant mediating role between HbA1c variability and the incidence of CVD.…”

Early Retinal Microvascular Changes Assessed with Swept-Source OCT Angiography in Type 1 Diabetes Patients without Retinopathy

“…Half of the diabetes patients were equipped with an insulin pump and/or had an FSL device for continuous glucose monitoring. Thanks to advances in glycemic control methods, these types of equipment improve glycemic management and are associated with a decrease in systemic vascular complications [ 26 , 27 , 30 ]. Interestingly, our investigation found that continuous glucose monitoring using devices such as the FSL was associated with higher retinal vascular densities in the SCP and DCP.…”

Revolutionizing diabetes care: new insulin pump and algorithm-based software for automatic insulin delivery

“…Notably, a comparative study investigating continuous subcutaneous insulin infusion (CSII) versus multiple daily injections (MDI) demonstrated positive results, indicating improved lifestyle flexibility and reduced stress related to hypoglycemia among CSII users [7] . Moreover, leading endorsements from reputable bodies such as American Diabetes Association (ADA) and International Society for Pediatric and Adolescent Diabetes (ISPAD) support the consideration of insulin pump therapy because of its proven safety and effectiveness [8] .…”

“…The satisfaction experienced by users can be attributed to a range of factors, including the meticulous design of the devices, the accuracy of the data provided, and the reduction in nocturnal alarm disruptions. This culmination of positive elements leads to better diabetesrelated outcomes and a notable reduction in stress levels [12,13] .…”