Sex Differences in Continuous Glucose Monitoring Metrics and Glucose Variability in Subjects with Type 1 Diabetes Treated with Advanced Hybrid Closed Loop Therapy: An Observational, Retrospective, One-Year Follow-Up Study

<b>Background</b>: Advanced hybrid closed-loop (aHCL) systems have improved glycemic control in individuals with type 1 diabetes (T1DM). However, it remains unclear whether their efficacy and safety differ by patient's sex, in view of known sex-related physiological and behavioral differences in disease control and management. <b>Methods</b>: This retrospective, single-center study included 176 adults with T1DM starting aHCL therapy with Medtronic MiniMed™ 780G. Continuous glucose monitoring (CGM) metrics, glycated hemoglobin (HbA1c), and glycemic variability (GV) indexes were collected at baseline, 6 months, and 12 months after starting aHCL therapy. Only patients with at least 70% sensor usage were included at each time point. The primary outcome was the assessment of sex-related differences in CGM metrics at 12 months. Secondary outcomes included changes in HbA1c and GV indexes by sex and over time. <b>Results</b>: TIR increased significantly at 6 (+6.6%, <i>p</i> < 0.001) and 12 months (+5.4%, <i>p</i> < 0.001), TAR decreased, and TBR remained stable. HbA1c was significantly reduced at both 6 and 12 months (-0.6%, <i>p</i> < 0.001). Improvements were consistent in both males and females, with females exhibiting better improvement in HbA1c compared to males (-0.4%, <i>p</i> = 0.049). No significant sex differences were found in CGM metrics at 12 months. GV indexes improved significantly in both groups, regardless of sex. At the multivariable analysis, only HbA1c <7.0% at baseline was associated with the achievement of the composite outcome (TIR > 70%, TBR < 4%, HbA1c < 7.0%). <b>Conclusions</b>: aHCL therapy improved glycemic control and GV in adults with T1DM, regardless of the patient's sex. These results support the generalizability of aHCL therapy and underscore the need to ensure equitable access to technologies rather than sex-specific adjustments.