Continuous glucose monitoring-derived time in range is associated with changes in arterial stiffness in type 2 diabetes.

Abstract

Current guidelines recommend continuous glucose monitoring (CGM) to complement HbA1c in glycemic assessment. While cross-sectional studies have reported associations between CGM-derived metrics and arterial stiffness in type 2 diabetes (T2D), longitudinal evidence remains limited. This study aimed to investigate the longitudinal associations of CGM metrics, particularly time in range (TIR) and coefficient of variation (CV), with changes in brachial-ankle pulse wave velocity (baPWV). This exploratory study analyzed data collected over 260 weeks from an ongoing prospective, multicenter, observational cohort. A total of 348 participants with type 2 diabetes and no history of symptomatic cardiovascular disease underwent baPWV measurements at baseline, 104 weeks, and/or 260 weeks. Participants were divided into two groups based on the median values of CGM-derived metrics and HbA1c at baseline, and the associations between each baseline value and longitudinal changes in baPWV were evaluated using mixed-effects models for repeated measures, adjusting for conventional atherosclerotic risk factors. The median change in baPWV from baseline was 60.1 cm/s (95% CI: 34.6 to 85.6) at 104 weeks and 130.3 cm/s (95% CI: 98.6 to 162.1) at 260 weeks (p < 0.001). The change over time in baPWV differed between the higher and lower TIR groups, with a significant interaction between group and time (p = 0.013) in the multivariable-adjusted model. This interaction remained significant even after further adjustment for HbA1c (p = 0.013). In contrast, baseline CV, other CGM-derived metrics, and HbA1c were not associated with longitudinal changes in baPWV. TIR was significantly associated with longitudinal changes in arterial stiffness in participants with type 2 diabetes, independent of HbA1c.