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Trends in cardiovascular risk factor management in type 1 diabetes by sex
Krystal K Swasey1, Trevor J Orchard1, Tina Costacou1
1Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA.
Insights
Intensive insulin therapy and HbA1c control improved for type 1 diabetes patients, but overall cardiovascular risk factor adherence remains low. Further interventions are needed to prevent complications.
Area of Science:
- Endocrinology
- Cardiovascular Medicine
- Diabetes Research
Background:
- The Diabetes Control and Complications Trial (DCCT) highlighted intensive management benefits for type 1 diabetes complications.
- However, DCCT did not extensively study cardiovascular disease (CVD) risk factors in type 1 diabetes.
- Control of CVD risk factors in type 1 diabetes remains under-researched.
Purpose of the Study:
- To assess trends in cardiovascular risk factors in type 1 diabetes.
- To evaluate the attainment of American Diabetes Association (ADA) guidelines for HbA1c, blood pressure, LDL cholesterol, and triglycerides.
- To understand complication prevention strategies in type 1 diabetes.
Main Methods:
- Longitudinal study of 658 individuals with childhood-onset type 1 diabetes.
- Biennial follow-up for up to 25 years, including surveys and examinations.
- Analysis of trends in HbA1c, blood pressure, LDL cholesterol, and triglyceride levels.
Main Results:
- Achievement of ADA recommendations for HbA1c increased significantly (9.7% to 25.6%).
- Blood pressure control remained high but unchanged (89.7% to 87.4%).
- LDL cholesterol control decreased significantly (62.3% to 39.7%).
- Intensive insulin therapy adoption rose (5.9% to 64.4%).
- Overall adherence to all four ADA recommendations remained low (6.8% to 7.6%).
Conclusions:
- While intensive insulin therapy and HbA1c control have improved, overall cardiovascular risk factor management in type 1 diabetes is insufficient.
- Low adherence to multiple cardiovascular risk factor guidelines necessitates further intervention.
- Targeted strategies are crucial for comprehensive CVD risk reduction in type 1 diabetes patients.
Aims:
DCCT showed that intensive type 1 diabetes management reduces complication incidence but did not focus on other cardiovascular disease risk factors, whose control in type 1 diabetes has not been well-studied. We assessed trends in cardiovascular risk factors in type 1 diabetes and attainment of concurrent American Diabetes Association (ADA) guidelines/recommendations (for HbA1c, blood pressure, LDL cholesterol, triglycerides) for complication prevention.
Methods:
Individuals with childhood-onset type 1 diabetes (n = 658; 49.4% women; baseline (1986-1988) median age 27 and duration 19 years) were followed biennially for up to 25 years, with surveys and/or examinations.
Results:
At the latest recorded follow-up, achievement of concurrent ADA recommendations increased for HbA1c (from 9.7 to 25.6%, p < .0001); was unchanged for blood pressure (from 89.7% to 87.4%, p = .36); and decreased for LDL cholesterol (from 62.3 to 39.7%, p < .0001). Adoption of intensive insulin therapy (from 5.9 to 64.4%, p < .0001) and hypercholesterolemia (from 67.3 to 78.9%, p = .0006) also increased. Overall, the proportion meeting all four recommendations was essentially unaltered (from 6.8% to 7.6%) (p = .69). Results were similar by gender.
Conclusions:
Although the adoption of intensive insulin therapy and obtaining ADA HbA1c recommendations are increasing, overall cardiovascular risk factor compliance remains low and merits further intervention.
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