Marga Gimenez

• MD, PhD
• MD, PhD at Hospital Clínic de Barcelona

This study aimed to develop a machine learning (ML) algorithm capable of determining cardiovascular risk in multimodal retinal images from patients with type 1 diabetes mellitus, distinguishing between moderate, high, and very high-risk levels. Radiomic features were extracted from fundus retinography, optical coherence tomography (OCT), and OCT an...

Background Since the arrival of continuous glucose monitoring (CGM), the relationship between the glucose management indicator (GMI) and HbA1c has been a topic of considerable interest in diabetes research. This study aims to explore the association between the GMI/HbA1c ratio and the presence of preclinical carotid atherosclerosis in type 1 diabet...

In the article cited above, affiliation information for author Ana Chico was inadvertently omitted. The complete affiliation list for this author is below.Department of Endocrinology and Nutrition, Hospital Santa Creu i Sant Pau, Barcelona, SpainUniversitat Autònoma de Barcelona, Barcelona, SpainCIBER-BBN, Madrid, Spain The authors apologize for th...

People living with type 1 diabetes (T1D) have an increased risk of cardiovascular disease (CVD), and it is the leading cause of morbidity and mortality in this population. CVD risk increases with each uncontrolled risk factor, even in individuals with good glycaemic control. Recommendations for assessing CVD risk in the T1D population are extended...

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 (T1D). We included 39 pairs of spontaneous MC from 13 participants, before and after switching from sensor-augmented pump to AHCL. Baseline time below range <70 mg/dL (TBR<70) was signif...

Aims To explore the relationship between severe hypoglycemia (SH) and hypoglycemia awareness with preclinical atherosclerosis in type 1 diabetes (T1D). Materials and Methods Cross‐sectional study in patients with T1D without cardiovascular disease (CVD), and with ≥1 of the following: ≥40 years, diabetic kidney disease, or ≥10 years of T1D duration...

Background Rebound hyperglycemia may occur following glucagon treatment for severe hypoglycemia. We assessed rebound hyperglycemia occurrence after nasal glucagon (NG) or injectable glucagon (IG) administration in patients with type 1 diabetes (T1D) and type 2 diabetes (T2D). Methods This was a pooled analysis of 3 multicenter, randomized, open-la...

Aims People with type 1 diabetes (T1D) have an increased risk of cardiovascular disease (CVD). The Mediterranean diet is associated with reduced CVD; however, the evidence in T1D is scarce. We aimed to analyse the relationships between adherence to the energy‐restricted Mediterranean diet (erMEDd) and carotid atherosclerosis. Materials and Methods...

Context The excess risk of fatal and non-fatal cardiovascular events is roughly twice as high in women than in men with type 1 diabetes (T1D). Objective To evaluate the impact of preeclampsia and parity on sex-based discrepancies in preclinical atherosclerosis and on the diagnostic performance of a cardiovascular risk scale. Design Cross-sectiona...

OBJECTIVE Advanced hybrid closed-loop systems (AHCL) have been shown to improve glycemic control and patient-reported outcomes in type 1 diabetes. The aim was to analyze the outcomes of two commercially available AHCL in real life. RESEARCH DESIGN AND METHODS A prospective study was performed, including adolescents and adults with type 1 diabetes,...

Ready-to-use glucagon represents a significant advancement in the management of severe hypoglycemia for people with diabetes and their caregivers. This indirect treatment comparison (ITC) evaluated the efficacy and safety differences among the three ready-to-use glucagon treatments, Baqsimi® (nasal glucagon), Gvoke® (glucagon injection) and Zegalog...

Aims: Evaluate the effectiveness of reimbursed flash glucose monitoring with optional alarms (FGM) in preventing severe hypoglycemia (SH) and reducing hypoglycemia exposure in T1D patients prone to hypoglycemia. Methods: Ambispective study in T1D patients treated with multiple daily injections (MDI) and prone to hypoglycemia, initiating reimburs...

Introduction: Information regarding the postpartum period in women with type 1 diabetes (T1D) is scarce. We aim to evaluate the relation of impaired hypoglycaemia awareness (IAH) in early pregnancy and breastfeeding status (its presence and duration) with severe postpartum hypoglycaemia (SH). Materials and methods: Retrospective cohort study of...

Introduction: Technical issues related to continuous subcutaneous insulin infusion (CSII), associated or not with continuous glucose monitoring (SAP), are handled by tele-technical assistance from the manufacturer. We analyze the characteristics of the most demanding patients of technical teleassistance. Material and methods: Patients with type...

Introduction: Physical activity (PA) is highly recommended in type 1 diabetes (T1D). Few studies have reported the amount of PA performed by individuals with T1D in their daily life, and there is no information about changes over time. Material and methods: Cross-sectional study in patients with T1D from a referral hospital recruited in two diff...

Background and aims: People with type 1 diabetes (T1D) present lipoprotein disturbances that could contribute to their increased cardiovascular disease (CVD) risk. We evaluated the relationship between lipoprotein alterations and atherosclerosis in patients with T1D. Methods and results: Cross-sectional study in subjects with T1D, without previo...

Glycemia assessment in people with type 1 diabetes (T1D) has focused on the time spent in different glucose ranges. As this time reflects the relative contributions to the finite duration of a day, it should be treated as compositional data (CoDa) that can be applied to T1D data. Previous works presented a tool for the individual categorization of...

IntroductionCardiovascular disease (CVD) is the leading cause of mortality in type 1 diabetes (T1D). However, there is a need for daily practice tools for identifying those more prone to suffer from these events. We aimed to assess the relationships between nuclear magnetic resonance (1H NMR)-based lipidomic analysis and several CVD risk variables...

Purpose To evaluate the diagnostic accuracy of machine learning (ML) techniques applied to Radiomic features extracted from optical coherence tomography (OCT) and OCT angiography (OCTA) images for diabetes mellitus (DM), diabetic retinopathy (DR) and referable DR (R-DR) diagnosis. Design Cross sectional analysis of a retinal image dataset from a p...

Mathematical modeling of the glucose–insulin system forms the core of simulators in the field of glucose metabolism. The complexity of human biological systems makes it a challenging task for the physiological models to encompass the entirety of such systems. Even though modern diabetes simulators perform a respectable task of simulating the glucos...

Background and aimsAlthough cardiovascular disease (CVD) remains the leading cause of mortality in type 1 diabetes (T1D), the use of cardioprotective drugs is scarce. We aimed to evaluate the impact of carotid ultrasonography (US) on the improvement in cardiovascular risk factors (CVRFs) in T1D.Methods and resultsT1D patients without CVD meeting cr...

OBJECTIVE To evaluate the concordance between the 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD (ESC/EASD-2019) and the Steno T1 Risk Engine (Steno-Risk) cardiovascular risk scales for individuals with type 1 diabetes (T1D) without cardiovascular disease (CVD) and to analyze the...

Introduction Physical activity (PA) is highly recommended in type 1 diabetes (T1D). Few studies have reported the amount of PA performed by individuals with T1D in their daily life, and there is no information about changes over time. Material and methods Cross-sectional study in patients with T1D from a referral hospital recruited in two differen...

Resumen Introducción Las incidencias técnicas relacionadas con infusores subcutáneos continuos de insulina (ISCI), asociados o no a monitorización continua de glucosa (SAP), son atendidas mediante teleconsulta técnica del fabricante. Analizamos las características de los pacientes más solicitantes del servicio de teleconsulta técnica. Material y...

Introduction Information regarding the postpartum period in women with type 1 diabetes (T1D) is scarce. We aim to evaluate the relation of impaired hypoglycaemia awareness (IAH) in early pregnancy and breastfeeding status (its presence and duration) with severe postpartum hypoglycaemia (SH). Materials and methods Retrospective cohort study of wome...

CIENTÍFICAImplantación masiva de lamonitorización continua de glucosaen personas con diabetes tipo 1 enuna Unidad de Diabetes dereferencia bajo financiación pública:estrategia y resultadosStrategy and results of the massiveimplementation of reimbursed continuousglucose monitoring in people with type 1diabetesEl uso de la monitorización continua de...

Objective: To evaluate and compare the efficacy and safety of 3 ready-to-use glucagon treatments for severe hypoglycemia in adults and children with diabetes: Baqsimi (nasal glucagon) , Gvoke (glucagon injection) , and Zegalogue (dasiglucagon injection) . Methods: A systematic literature review was conducted to identify randomized clinical trials a...

Aims Evaluate the relationship between high and low exposure continuous glucose monitoring (CGM)-derived glucometrics and micro- and macrovascular complications in type 1 diabetes (T1D). Methods Cross-sectional study in T1D without cardiovascular disease (CVD) and with ≥1 of the following: ≥40 years, diabetic nephropathy, or ≥10 years of diabetes...

IntroductionSevere hypoglycemic events (SHE) represent a clinical and economic burden in patients with diabetes. Nasal glucagon (NG) is a novel treatment for SHEs with similar efficacy, but with a usability advantage over injectable glucagon (IG) that may translate to improved economic outcomes. The economic implications of this usability advantage...

Nocturnal hypoglycemia (NH) is one of the most challenging events for multiple dose insulin therapy (MDI) in people with type 1 diabetes (T1D). The goal of this study is to design a method to reduce the incidence of NH in people with T1D under MDI therapy, providing a decision-support system and improving confidence toward self-management of the di...

Introduction The management of type 1 diabetes (T1D) is especially complex during adolescence when youths are transferred to adult care centres. The objectives of this qualitative study were to: a) determine the expectations of young T1D patients prior to transfer, b) evaluate the transfer process between the 2 centres, and c) evaluate the therapeu...

The purpose of this study is to investigate potential associations between optical coherence tomography angiography (OCTA) parameters and diabetic kidney disease (DKD) categories in type 1 diabetes mellitus (T1DM) patients and controls. A complete ocular and systemic examination, including OCTA imaging tests and bloods, was performed. OCTA paramete...

PurposeInformation on the association between diet and cardiovascular disease (CVD) in type 1 diabetes (T1D) is scarce. We assessed the association between biomarkers of fatty acid (FA) intake and the presence of carotid plaques (a surrogate marker of future CVD events) in this high-risk population.Methods Cross-sectional study in 167 consecutive T...

Background Hyperglycemia and obesity are associated with a worse prognosis in subjects with COVID-19 independently. Their interaction as well as the potential modulating effects of additional confounding factors is poorly known. Therefore, we aimed to identify and evaluate confounding factors affecting the prognostic value of obesity and hyperglyce...

Background: Although cardiovascular disease (CVD) remains the leading cause of mortality in type 1 diabetes (T1D), the use of cardioprotective drugs is scarce. We aimed to evaluate the impact of carotid ultrasonography (US) on the improvement in cardiovascular risk factors (CVRFs) in T1D. Methods: T1D patients without CVD meeting criteria for lipid...

Introduction: Data regarding efficacy of second-generation basal insulins (BI) using continuous glucose monitoring (CGM) come from clinical trials. We evaluated the effectiveness of insulin glargine 300 U/ml (Gla-300) compared to insulin degludec 100 U/ml (IDeg-100) in terms of percentage of time in range (TIR); 70-180 mg/dl was obtained from CGM...

The purpose of this study was to evaluate specifically the relationship between glycated haemoglobin (HbA1c) levels and retinal optical coherence tomography (OCT) and OCT angiography (OCTA) parameters in type 1 Diabetes Mellitus (DM). A total of 478 type 1 DM patients and 115 controls were included in a prospective OCTA trial (ClinicalTrials.gov NC...

Background and aims Information regarding inflammation and cardiovascular disease (CVD) risk in type 1 diabetes (T1D) or preeclampsia (PE) is scarce. We assessed differences in inflammation markers according to the presence of both conditions and their association with atherosclerosis. Methods and results We recruited 112 women without CVD and las...

Automated insulin delivery (AID) is the most recent advance in type 1 diabetes (T1D) management. It has the potential to achieve glycemic targets without disabling hypoglycemia, to improve quality of life and reduce diabetes distress and burden associated with self-management. Several AID systems are currently licensed for use by people with T1D in...

Preclinical testing and validation of therapeutic strategies developed for patients with type 1 diabetes (T1D) require a cohort of virtual patients (VPs). However, current simulators provide a limited number of VPs, lack real-life scenarios, and inadequately represent intra- and inter-day variability in insulin sensitivity and blood glucose (BG) pr...

The time spent in glucose ranges is a common metric in type 1 diabetes (T1D). As the time in one day is finite and limited, Compositional Data (CoDa) analysis is appropriate to deal with times spent in different glucose ranges in one day. This work proposes a CoDa approach applied to glucose profiles obtained from six T1D patients using continuous...

Background and Aims Glycoproteins play a key role in inflammatory and cardiometabolic processes. Their implication in atherosclerosis in type 1 diabetes (T1D) is unknown. We assessed the relationships between classic inflammatory markers, glycoproteins measured by nuclear magnetic resonance (¹H-NMR), and preclinical atherosclerosis in these patient...

Objective Evaluate the results of a healthcare and therapeutic education program (TEP) aimed at young patients with type 1 diabetes (T1D) transferred from a pediatric center. Methodology This was a prospective, pre-postest in young T1D patients transferred from 2005–2015. The program has four phases: coordinated transfer, evaluation and objective...

Background and aims Despite using sensor-augmented pump therapy (SAPT) with predictive low-glucose management (PLGM), hypoglycemia is still an issue in patients with type 1 Diabetes (T1D). Our aim was to determine factors associated with clinically significant hypoglycemia (<54 mg/dl) in persons with T1D treated with PLGM-SAPT. Method ology: This...

Background Calcium is an essential ion for pathogen survival and virulence and is involved in the regulation of the inflammatory response. Hypocalcemia is a common laboratory finding in critically ill patients. Data regarding levels of calcium in SARS-CoV-2 infection is scarce. Patients with SARS-CoV-2 infection who present with hypocalcemia could...

Aims Evaluate the role of plasma metabolomics in atherosclerosis according to the presence of type 1 diabetes (T1D) or previous preeclampsia. Methods We recruited 105 women without cardiovascular disease and last pregnancy ≥5 years previously, divided according to the presence of T1D or previous preeclampsia. Preclinical atherosclerosis was define...

AimsSpain has been one of the worst affected countries by the COVID-19 pandemic. A very strict lockdown at home was imposed with a tough restriction of mobility. We aimed to evaluate the impact of this exceptional scenario on glucose profile of patients with type 1 diabetes (T1D) prone to hypoglycaemia using sensor-augmented pump (SAP).Methods Pati...

Objective: Evaluate the results of a healthcare and therapeutic education programme (TEP) aimed at young patients with type 1 diabetes (T1D) transferred from a paediatric centre. Methodology: This was a prospective, pre-postest in young T1D patients transferred from 2005-2015. The programme has four phases: coordinated transfer, evaluation and o...

OBJECTIVE To evaluate the safety and performance of a new multivariable closed-loop glucose controller with automatic carbohydrate recommendation (MCL) during and after unannounced and announced exercise in adults with type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS A randomized, three-arm, crossover clinical trial was conducted. Participants c...

Abstract Background Lipoprotein disturbances have been associated with increased cardiovascular disease (CVD) risk in type 1 diabetes mellitus (T1DM). We assessed the advanced lipoprotein profile in T1DM individuals, and analysed differences with non-diabetic counterparts. Methods This cross-sectional study involved 508 adults with T1DM and 347 con...

Aim To evaluate frequency of hypoglycaemia unawareness (HU) in patients with type 1 diabetes(T1D) transferred from Paediatrics following a specific therapeutic education programme (TEP) in an adult hospital. Patients and method Young patients transferred from 2009-2011 were evaluated. The TEP included a coordinated transfer process, individual app...

Aims Spain has been one of the worst affected countries by the COVID-19 pandemic. A very strict lockdown at home was imposed with a tough restriction of mobility. We aimed to evaluate the impact of this exceptional scenario on glucose profile of patients with T1D prone to hypoglycemia using standalone continuous glucose monitoring. Methods Patient...

Aims Persistence of lipoprotein abnormalities in type 1 diabetes (T1D) and/or preeclampsia could be associated with cardiovascular disease (CVD). We assessed differences in the advanced lipoprotein profiles according to the presence of both conditions and their differential association with atherosclerosis. Material and methods We recruited 112 wo...

Aim Although insulin resistance (IR) is a growing trait among type 1 diabetes (T1D) population, its relationship with atherosclerosis has been scarcely studied. We assessed the association between IR indexes and carotid atherosclerosis in T1D, a population at high cardiovascular disease (CVD) risk. Materials and Methods We evaluated 191 participan...

Background and aims Tools to detect type 1 diabetes (T1D) individuals at overt cardiovascular disease (CVD) risk are scarce. We aimed to assess the usefulness of the score “Steno Type 1 Risk Engine” (Steno‐Risk) to identify T1D patients with advanced carotid atherosclerosis. Material and methods T1D patients without CVD with at least one of the fo...

Background: Glycemic variability is an important factor to consider in diabetes management. It can be assessed with multiple glycemic variability metrics and quality of control indices based on Continuous Glucose Monitoring (CGM) recordings. For this, robust, repeatable calculation is important. A widely used tool for automated assessment is the E...

(1) Background: nocturnal hypoglycemia (NH) is one of the most challenging side effects of multiple doses of insulin (MDI) therapy in type 1 diabetes (T1D). This work aimed to investigate the feasibility of a machine-learning-based prediction model to anticipate NH in T1D patients on MDI. (2) Methods: ten T1D adults were studied during 12 weeks. In...

Objective Less than one third of patients with type 1 diabetes mellitus (T1DM) achieve the cut-off value proposed as good metabolic control by most guidelines, HbA1c <7 %. However, HbA1c reductions and prevention of severe hypoglycemia (SH) have shown clinically relevant benefits. The study objective therefore was to assess the effectiveness of con...

Objective: To evaluate frequency of hypoglycaemia unawareness (HU) in patients with type 1 diabetes (T1D) transferred from Paediatrics following a specific therapeutic education programme (TEP) in an adult hospital. Patients and methods: Young patients transferred from 2009-2011 were evaluated. The TEP included a coordinated transfer process, in...

Introduction The use of statins in non-selected type 1 diabetes (T1D) populations is low. We assessed the prevalence and factors associated with statin treatment in patients meeting criteria for this therapy for primary prevention of cardiovascular disease (CVD). Material and Methods From 2015 to 2018, T1D patients from a tertiary hospital were se...

Objective: The inverse relationship between overall glucose control and hypoglycemia risk is weakened by the use of real-time continuous glucose monitoring (rtCGM). We assess the relationship between glucose control and hypoglycemia in people with type 1 diabetes using multiple-dose injection (MDI) regimens, including those at highest risk of hypo...

Purpose Although preeclampsia is a well-established cardiovascular risk factor (CVRF) in the general population, its role in type 1 diabetes (T1D) has been scarcely studied. We assessed the association between preeclampsia and preclinical atherosclerosis in T1D. Methods We recruited 112 women without cardiovascular disease and last pregnancy ≥5 ye...

Current Continuous Glucose Monitors (CGM) exhibit increased estimation error during periods of aerobic physical activity. The use of readily-available exercise monitoring devices opens new possibilities for accuracy enhancement during these periods. The viability of an array of physical activity signals provided by three different wearable devices...

Aims: To evaluate the impact of a prepregnancy care (PPC) programme, beyond HbA1c, on hypoglycaemia awareness and glycaemic variability (GV). Methods: Prospective pilot study. We selected women with Type 1 diabetes who initiated a PPC programme with normal hypoglycaemia awareness (n = 24). Hypoglycaemia awareness, hypoglycaemic events and GV der...

Concomitant glucagon delivery in a dual-hormone artificial pancreas system might overcome the limitations of insulin-only systems, potentially leading to improved hypoglycemia mitigation. However, current dual-hormone systems have not shown clearly its superiority. This work presents a novel dual-hormone system based on a parallel control structure...

Background: Diabetic patients treated with intensive insulin therapies require a tight glycemic control and may benefit from advanced tools to predict blood glucose (BG) concentration levels and hypo/hyperglycemia events. Prediction systems using machine learning techniques have mainly focused on applications for sensor augmented pump (SAP) therap...

Aim To evaluate the impact of impaired awareness of hypoglycemia (IAH) on metabolic control and pregnancy outcomes in women with type 1 diabetes. Material and Methods This was a single‐center prospective cohort study of singleton pregnant women with type 1 diabetes. IAH was assessed at the first antenatal visit using the Clarke's test (score≥3). D...

Resumen Objetivo Menos de un tercio de los pacientes con diabetes tipo 1 (DT1) consiguen el objetivo de punto de corte establecido como control metabólico óptimo (HbA1c < 7%). Sin embargo, reducciones porcentuales de HbA1c y la prevención de hipoglucemias graves (HG) han demostrado beneficios clínicamente relevantes. Por ello, el objetivo de este...

Introduction: The use of statins in non-selected type 1 diabetes (T1D) populations is low. We assessed the prevalence and factors associated with statin treatment in patients meeting criteria for this therapy for primary prevention of cardiovascular disease (CVD). Material and methods: From 2015 to 2018, T1D patients from a tertiary hospital wer...

Introduction To describe and compare the routine use of continuous subcutaneous insulin infusion (CSII) in type 1 diabetes (T1D) patients with and without continuous glucose monitoring (CGM) in routine clinical practice and its relationship with glycemic outcomes. Methods Retrospective observational case–control study collecting routine use of CSI...

Background: Predicting insulin-induced postprandial hypoglycemic events is critical for the safety of type 1 diabetes patients because an early warning of hypoglycemia facilitates correction of the insulin bolus before its administration. The postprandial hypoglycemic event counts can be lowered by reducing the size of the bolus based on a reliabl...

Objective There is scarce information regarding the performance of a specific, structured education program addressed to patients with type 1 diabetes (T1D) using continuous subcutaneous insulin infusion (CSII) including both routine use of the therapy and patient experience evaluation. We aimed to assess the routine use of CSII and patient's exper...

The aim of this study was to apply a methodology based on compositional data analysis (CoDA) to categorise glucose profiles obtained from continuous glucose monitoring systems. The methodology proposed considers complete daily glucose profiles obtained from six patients with type 1 diabetes (T1D) who had their glucose monitored for eight weeks. The...

Aims: The aim was to evaluate the effectiveness of sensor-augmented pump therapy with predictive low-glucose suspend function (SAP-PLGS) in real-world use in children and adults with type 1 diabetes (T1D). Methods: Patients with T1D treated with the MiniMed 640G® pump with PLGS function at three referral hospitals were retrospectively evaluated....

Aim To assess an artificial pancreas system during aerobic (AeE) and anaerobic exercise (AnE). Methods A pilot clinical trial on five subjects with type 1 diabetes (four males) aged 37 ± 10.9 years, diabetes diagnosed 21.2 ± 12.2 years before, insulin pump users, and with a mean HbA1c level of 7.8 ± 0.5%. Every subject did three AeE and three AnE...

Objective: There is scarce information regarding the performance of a specific, structured education program addressed to patients with type 1 diabetes (T1D) using continuous subcutaneous insulin infusion (CSII) including both routine use of the therapy and patient experience evaluation. We aimed to assess the routine use of CSII and patient's exp...

There is an inverse relationship between A1C and hypoglycemia which may be impacted by use of continuous glucose monitoring (CGM). Using data from the HypoDE clinical trial, we compared usual care to real-time CGM in subjects with type 1 diabetes using MDI and impaired hypoglycemia awareness or recent severe hypoglycemia. Data from 149 subjects (75...

We revisited the well-known inverse relationship between A1C and hypoglycemia using data from phase 1 of the Diamond clinical trial that compared usual care to real-time continuous glucose monitoring (CGM) in subjects with type 1 diabetes using MDI and with A1C levels from 7.5% to 9.9%. Data from 157 subjects (104 and 53 in the CGM and control grou...