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Cardiovascular risk management in people with type 1 diabetes: performance using three guidelines

Rita Delphine Maiko Varkevisser1, Erwin Birnie2,3, Charlotte E Vollenbrock4

  • 1Department of Endocrinology, University Medical Center Groningen, Groningen, The Netherlands r.d.m.varkevisser@umcg.nl.

BMJ Open Diabetes Research & Care
|July 20, 2022
PubMed

Insights

Cardiovascular risk management is underutilized in type 1 diabetes mellitus (T1DM), especially for younger patients. Many patients on medication do not meet treatment targets, indicating a need to explore undertreatment factors.

Area of Science:

  • Cardiology
  • Endocrinology
  • Pharmacology

Background:

  • Cardiovascular disease (CVD) is the primary cause of death in individuals with type 1 diabetes mellitus (T1DM).
  • Effective cardiovascular risk management is crucial for T1DM patient outcomes.
  • This study evaluates lipid and blood pressure management adherence to current guidelines in T1DM patients.

Purpose of the Study:

  • To assess the performance of lipid and blood pressure management in T1DM patients based on three distinct clinical guidelines.
  • To identify discrepancies between recommended and prescribed lipid-lowering (LLM) and antihypertensive medications (AHM).
  • To evaluate the achievement of treatment targets for lipid and blood pressure in T1DM patients.

Main Methods:

  • Included 1855 adult T1DM patients on insulin for over a year.
  • Assessed LLM and AHM prescription rates against Dutch, ADA, and NICE guidelines.
  • Analyzed concordance between guideline recommendations and prescribed medications across age groups.
  • Evaluated achievement of low-density lipoprotein-cholesterol and blood pressure targets.

Main Results:

  • Lipid-lowering and antihypertensive medications were prescribed to only 19% and 17% of T1DM patients, respectively.
  • Prescription rates for LLM and AHM varied significantly (22%-46% and 52%-75%) based on the guideline used.
  • Younger patients showed higher discordance between recommended and prescribed treatments.
  • Only 50% of patients on LLM achieved LDL-C targets (without CVD), and 46% on AHM achieved blood pressure targets.

Conclusions:

  • Significant undertreatment of lipid and blood pressure management exists in T1DM patients, particularly in younger individuals.
  • Treatment targets are frequently unmet even for patients on medication.
  • Discrepancies among guidelines and undertreatment warrant further investigation into influencing factors.
Abstract

Keywords:
diabetes complicationsdiabetes mellitus, type 1guideline adherence

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