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Cardiovascular Disease in Adults with Type 1 Diabetes: Looking Beyond Glycemic Control

Rachel G Miller1, Tina Costacou2

  • 1Department of Epidemiology, School of Public Health, University of Pittsburgh, 130 N. Bellefield Avenue, Pittsburgh, PA, 15213, USA.

Current Cardiology Reports
|August 10, 2022
PubMed

Insights

People with type 1 diabetes face higher cardiovascular disease (CVD) risks. Beyond blood sugar control, factors like insulin resistance and inflammation significantly impact CVD risk in type 1 diabetes.

Area of Science:

  • Endocrinology
  • Cardiology
  • Metabolic Diseases

Background:

  • Type 1 diabetes (T1D) is associated with elevated cardiovascular disease (CVD) risk, even with improved glycemic control.
  • Current understanding of CVD risk in T1D is incomplete, necessitating exploration beyond glycemia.

Purpose of the Study:

  • To review the interplay between glycemia and CVD risk in adults with T1D.
  • To summarize evidence on non-glycemic factors contributing to excess CVD risk in T1D.
  • To identify gaps and future directions for CVD prevention in T1D.

Main Methods:

  • Literature review focusing on studies examining CVD risk factors in type 1 diabetes.
  • Synthesis of evidence on established and emerging risk factors beyond glycemic control.
  • Analysis of current guidelines and their limitations for CVD prevention in T1D.

Main Results:

  • Glycemic control alone does not fully account for the increased CVD risk in type 1 diabetes.
  • Factors such as insulin resistance, weight gain, sex differences, genetics, and inflammation play significant roles.
  • Emerging risk markers including lipid subclasses and epigenetic modifications warrant further investigation.
  • Lack of T1D-specific guidelines for lipids, blood pressure, and physical activity hinders optimal CVD prevention.

Conclusions:

  • Optimal CVD risk management in type 1 diabetes requires addressing factors beyond glycemic control.
  • Novel markers and precision medicine approaches show promise for improved CVD prediction.
  • Development and implementation of T1D-specific guidelines are crucial for effective CVD prevention.
Abstract

Keywords:
Cardiovascular diseaseClinical targetsGlycemic controlRisk factorsSex differencesType 1 diabetes

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