Clara Solà

Aims: The aims of this review were to (1) estimate the ratio of male and female participants with type 1 diabetes (T1D) in clinical exercise studies, (2) ascertain the degree to which menstruation has been considered and (3) characterize the number of studies in which the elderly have been included. Materials and Methods: Original clinical exercise research articles in individuals with T1D from 1985 to 2025 on PubMed were screened. The number and age of participants were analysed. A standardized menstrual‐status tiering system was used to assess the quality of menstrual cycle (MC) information of females: Gold, Silver and Bronze were awarded based on the level of methodological control, including verification of MC characteristics and hormonal profiling. Results: Of a total of 315 included studies, the majority (81%) contained a mixed‐sex population with an overall male dominance in participant ratio (57% males vs 43% females). Since 1985, there have been six studies conducted exclusively in females compared to the 54 studies done in men, with six times fewer total participants ( n = 99 vs n = 671, respectively). Across all studies, the mean age of participants was 29 ± 7 years, with only one study conducted solely in post‐menopausal females. MC status was reported in 30 studies, 6 of which were graded Bronze and 3 Silver. None achieved Gold. Conclusions: Females and the elderly are under‐represented in clinical exercise trials conducted in people with T1D. These data highlight the need for intensified efforts to bridge the current sex‐and age‐data gaps so as to improve practical implementation and clinical translation.

Background/objectives: Individuals with type 1 diabetes (T1DM) face an elevated risk of cardiovascular disease (CVD), yet the factors driving atherosclerosis remain unclear. This study aimed to assess factors associated with preclinical atherosclerosis development or progression in T1DM. Methods: We conducted a prospective study in T1DM individuals without established CVD, aged ≥40 years, with diabetic kidney disease and/or ≥10 years of T1DM plus another cardiovascular risk factor (CVRF). Baseline evaluation followed a standardized CV risk assessment protocol, including carotid ultrasound and cardiovascular risk estimation using the Steno Type 1 Risk Engine (ST1RE). Ultrasound was repeated after 3–5 years; progression was defined as an increase in plaque number. CVRF control was considered optimal when LDL-cholesterol was within target based on atherosclerotic burden, blood pressure p < 0.05), 40.4% experienced progression. Older age (OR 1.38 [1.1–1.8]) and active smoking (OR 3.29 [1.4–7.5]) were significant predictors of progression. Baseline cardiovascular risk measured by the ST1RE independently predicted progression (OR 1.09 [1.03–1.15]) after adjusting for other CVRFs. Persistent smoking (OR 2.52 [1.06–5.99]) and baseline ST1RE (OR 1.06 [1.02–1.11]) remained significant after accounting for baseline and follow-up CVRFs. Conclusions: Despite improved CVRF control, atherosclerosis progression is common in T1D. ST1RE may help identify individuals at highest risk for targeted preventive strategies.

This study aimed to evaluate the impact of advanced hybrid closed loop (AHCL) on glycemic control throughout the menstrual cycle (MC) in women with type 1 diabetes. We included 39 pairs of spontaneous MCs from 13 participants, before and after switching from sensor-augmented pump to AHCL. Baseline time below range <70 mg/dL (TBR <70) was significantly higher during the midfollicular phase than during late luteal phase (5.7% ± 5.0% vs. 4.1% ± 3.0%), but similar time in range 70–180 mg/dL (TIR) was observed throughout the MC. After switching to AHCL, a reduction in TBR <70 and an increase in TIR were observed in all phases. Phase-dependent changes in insulin infusion were detected and pre-existing differences in TBR <70 were eradicated (3.5% ± 3.2% vs. 3.0% ± 3.0%). However, TIR became significantly higher during the early follicular phase than during the late luteal phase (79.1% ± 9.3% vs. 74.5% ± 10.0%). In conclusion, AHCL improved glycemic control throughout the MC, but performance differed according to phase.