Cardiovascular risk factors and their management in 1282 adult people with type 1 diabetes

University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
Current Medical Research and Opinion (Impact Factor: 2.65). 01/2008; 23(12):2921-7. DOI: 10.1185/030079907X233313
Source: PubMed


The mortality rate in people with type 1 diabetes (T1D) is over three-times that of their counterparts without diabetes. The underlying reason for this in the developed world is cardiovascular disease (CVD). Strict control of CVD risk factors, for which guidelines now exist, reduces morbidity and mortality. The objective of this study was to determine if these guidelines are being achieved.
Data were collected on 1282 adults with T1D from hospitals in the city of Birmingham, UK. Guidelines were those recommended by Joint British Societies: blood pressure (BP) 130/80 mmHg, total cholesterol (TC) 4 mmol/L, non-smoking status, HbA(1c) 6.5% and body mass index (BMI) 25 kg/m(2).
The mean age was 46 years and duration of diabetes 21 years. Data on CVD risk factors were poorly documented, with a minimally defined dataset of TC, smoking history and HbA(1c) being completely recorded in only 72% of people. CVD risk factor targets were also poorly achieved with only 0.7% of patients achieving all minimal dataset targets. HbA(1c) and TC targets were those most poorly achieved.
This is the largest study of CVD risk factors in the UK and the only one to audit the standard of care provided against recent guidelines published by the joint societies. The results show that CVD risk factors are poorly recorded and sub-optimally managed in adults with T1D. Far more aggressive management is essential if mortality rates for T1D in the UK are to be reduced.

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    ABSTRACT: Cardiovascular disease (CVD) is a major cause of mortality in type 1 diabetes mellitus (T1D). However, evidence of its risks and management is often extrapolated from studies in type 2 diabetic (T2D) patients or the general population. This approach is unsatisfactory given that the underlying pathology, demographics and natural history of the disease differ between T1D and T2D. Furthermore, with a rising life expectancy, a greater number of T1D patients are exposed to the cardiovascular (CV) risk factors associated with an ageing population. The aim of this review is to examine the existing literature around CVD in T1D. We pay particular attention to CVD prevalence, how well we manage risk, potential biomarkers, and whether the studies included the older aged patients (defined as aged over 65). We also discuss approaches to the management of CV risk in the older aged. The available data suggest a significant CVD burden in patients with T1D and poor management of CV risk factors. This is underpinned by a poor evidence base for therapeutic management of CV risk specifically for patients with T1D, and in the most relevant population – the older aged patients. We would suggest that important areas remain to be addressed, particularly exploring the risks and benefits of therapeutic approaches to CVD management in the older aged.
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