ESC Congress 2026 Abstract · Oct 26, 2026

Low mediterranean diet adherence is associated with subclinical cardiovascular and endothelial dysfunction in well-controlled type 1 diabetes using hybrid closed-loop systems

By Thymis J, Kounntouri A, Georgiopoulos G et al.

Background: The Mediterranean diet (MD) improves cardiometabolic risk. However, its impact on type 1 diabetes (T1D) management remains understudied. Purpose: We aim to evaluate the association of adherence to MD in adults with T1D using hybrid closed loop insulin deliver system (HCLS) with glucose, insulin metrics, and subclinical markers of endothelial, myocardial and vascular function. Methods: In 90 adults with T1D using the MiniMedTM-780G system we evaluated: (a) adherence to the MD, using the Mediterranean Diet Adherence Screener (MEDAS); (b) glucose and insulin metrics, via CareLink™Clinic software and assessment of time in range within normal glucose levels (TIR); vascular function via pulse wave velocity (PWV); (d) the perfused boundary region (PBR) of the sublingual arterial microvessels, as a marker of endothelial glycocalyx integrity; and (e) myocardial function via left ventricular global longitudinal strain (LVGLS). Results: The mean HbA1C and BMI was 6.98±0.63% and 26.7 ± 5.0 kg/m2 respectively. We stratified the participants in three MD score categories: 21(23.33%) patients presented with low adherence (LA), 55(61.11%) with moderate adherence(MA) and 14 (15.55%) with high adherence(HA). HbA1c time in range within normal glucose levels (TIR) did not significantly differ between groups (p>0.05).Compared to MA and HA group, the LA group showed higher auto-correction boluses (9.87±5.64IU vs 7.05±4.77IU vs 14.34±12.07IU respectively, p=0.015), PWV(9.08±3.39 vs 8.75±2.51 vs 11.57±4.36m/s respectively, p=0.017), PBR4-25 (2.17±0.20 vs 2.08±0.13 vs 2.26±0.15μm respectively, p=0.022) and LV GLS(-18.74±2.34 vs -20.82±2.11 vs -18.95±2.38% respectively, p=0.017). Conclusions: A lower adherence to MD is associated with increased arterial stiffness and impaired endothelial and myocardial function, regardless of effective glycemic control by use of hybrid closed loop insulin deliver system

doi.org/10.1093/eurheartj/ehag785.3491Open accessPopulations