Associations Between Arterial Stiffness and Metabolic Target in Children and Adolescents With Type 1 Diabetes Treated in a Modern Setting.

To investigate the prevalence of elevated arterial stiffness and associations to known and potentially novel risk factors in a modern European technology-based cohort of children and adolescents with type 1 diabetes. Cross-sectional study, including 127 children recruited from Pediatric Diabetes Departments across Eastern Denmark between May 2022 and January 2024. Arterial stiffness was assessed as carotid-femoral pulse-wave-velocity (cfPWV) using the Sphygmocor XCEL system. Unadjusted and adjusted linear regression models explored associations between cfPWV and other risk factors. Adjustments included age, sex, diabetes duration, time-in-range, hemoglobin A1c (HbA1c), body mass index (BMI) -score, low-density lipoprotein (LDL)-cholesterol, and mean arterial pressure (MAP). Median (interquartile range [IQR]) age was 14.2 years (12.0, 16.4), diabetes duration was 4.7 years (2.7, 8.4), HbA1c level was 7.0% (6.5, 7.9), (53 mmol/l: 48-63), time-in-range was 63% (53-75), and 52% were male. The majority were treated with continuous-subcutaneous-insulin-infusion (82%), and all (except two) used continuous-glucose-monitors. The prevalence of elevated arterial stiffness (cfPWV -score over the 90th percentile) was 16%. Unadjusted analyses demonstrated higher cfPWV was associated with longer diabetes duration, higher age, HbA1c, MAP, and liver stiffness, and lower time-in-range and insulin sensitivity. Higher cfPWV remained associated with higher age (standardized (confidence interval (CI) 95%): 0.38 (0.27, 0.48);   < 0.001) and lower time-in-range (-0.15 ((-0.26), (-0.03));   < 0.011) after adjustment. Despite modern treatment technology and better overall metabolic control, children and adolescents with type 1 diabetes present with a high prevalence of elevated arterial stiffness. Higher arterial stiffness was associated with higher age and lower time-in-range, independent of other risk factors, including HbA1c.