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

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.