Type 1 diabetes management: Room for improvement

Abstract

Aims/hypothesis: Optimal diabetes care and risk factor management are important to delay micro- and macrovascular complications in individuals with type 1 diabetes (T1D). Ongoing improvement of management strategies requires the evaluation of target achievement and identification of risk factors in individuals who do (or do not) achieve these targets.

Methods: Cross-sectional data were collected from adults with T1D visiting six diabetes centers in the Netherlands in 2018. Targets were defined as glycated hemoglobin (HbA1c) <53 mmol/mol, low-density lipoprotein-cholesterol (LDL-c) <2.6 mmoL/L (no cardiovascular disease [CVD] present) or <1.8 mmoL/L (CVD present), or blood pressure (BP) <140/90 mm Hg. Target achievement was compared for individuals with and without CVD.

Results: Data from 1737 individuals were included. Mean HbA1c was 63 mmol/mol (7.9%), LDL-c was 2.67 mmoL/L, and BP 131/76 mm Hg. In individuals with CVD, 24%, 33%, and 46% achieved HbA1c, LDL-c, and BP targets respectively. In individuals without CVD these percentages were 29%, 54%, and 77%, respectively. Individuals with CVD did not have any significant risk factors for HbA1c, LDL-c, and BP target achievement. In comparison, individuals without CVD were more likely to achieve glycemic targets if they were men and insulin pump users. Smoking, microvascular complications, and the prescription of lipid-lowering and antihypertensive medication were negatively associated with glycemic target achievement. No characteristics were associated with LDL-c target achievement. Microvascular complications and antihypertensive medication prescription were negatively associated with BP target attainment.

Conclusion: Opportunities for improvement of diabetes management exist for the achievement of glycemic, lipid, and BP targets but may differ between individuals with and without CVD.

Keywords: 1型糖尿病; LDL; LDL。; blood glucose; blood pressure; cardiovascular diseases; cholesterol; diabetes mellitus type 1; lipid metabolism; 心血管疾病; 胆固醇; 脂代谢; 血压; 血糖.

FIGURE 1

Distribution of targets and percentage of targets achieved for glycated hemoglobin (HbA1c), LDL‐cholesterol (LDL‐c), and systolic blood pressure. In blue the no cardiovascular disease (CVD) group, in pink the CVD group, and in black the total group are shown. (A) percentage of individuals achieving the target HbA1c of <53 mmol/mol (7.0%), (B) percentage of individuals achieving target LDL‐c of <1.8 mmoL/L (CVD) and <2.6 mmoL/L (no CVD), (f) percentage of individuals achieving blood pressure target <140/90 mm Hg. *** = p value <0.001.

FIGURE 2

Odds ratios of HbA1c target achievement for those with and without cardiovascular disease, adjusted for age. AHM, antihypertensive medication; BMI, body mass index; CSII, continuous subcutaneous insulin infusion; CVD, cardiovascular disease; eGFR, estimated glomerular filtration rate; HbA1c, glycated hemoglobin; LLM, lipid lowering medication; OR, odds ratio.

FIGURE 3

Odds ratios of LDL‐cholesterol (LDL‐c) target achievement for those with and without cardiovascular disease, adjusted for age. AHM, antihypertensive medication; BMI, body mass index; CSII, continuous subcutaneous insulin infusion; CVD, cardiovascular disease; eGFR, estimated glomerular filtration rate; LLM, lipid lowering medication; OR, odds ratio.

FIGURE 4

Odds ratios of blood pressure target achievement for those with and without cardiovascular disease, adjusted for age. AHM, antihypertensive medication; BMI, body mass index; CSII, continuous subcutaneous insulin infusion; CVD, cardiovascular disease; eGFR, estimated glomerular filtration rate; LLM, lipid lowering medication; OR, odds ratio.