Long-term adherence to LDL targets lacking in type 1 diabetes
The percentage of adults with type 1 diabetes who met LDL cholesterol recommendations set by the American Diabetes Association has steadily declined over 25 years of follow-up, with the percentage falling as LDL targets tightened and the incidence of hypercholesterolemia rose, according to an analysis of the Pittsburgh Epidemiology of Diabetes cohort.
“Unfortunately, years after the advent of intensive insulin therapy, the rates of CVD are still higher in type 1 diabetes compared to the general population, suggesting that tighter control of non-glycemic factors might be beneficial,” Krystal K. Swasey, MPH, of the department of epidemiology at the University of Pittsburgh, and colleagues wrote. “However, to what extent improvements in cardiovascular risk factor control have occurred in the general type 1 diabetes population and whether they may differ between men and women, is not clear.”
Swasey and colleagues analyzed data from 658 adults with childhood-onset type 1 diabetes participating in the Pittsburgh Epidemiology of Diabetes Complications study, a historical, prospective cohort study of risk factors for complications resulting from childhood-onset diabetes (49.4% women; median baseline age, 27 years; mean diabetes duration, 18.5 years). Baseline exam was conducted between 1986 and 1988; biennial surveys and clinical exams were conducted during 25 years of follow-up. At each clinical assessment, researchers classified participants as falling within or outside the annual ADA guidelines corresponding to the study period for HbA1c, blood pressure, LDL cholesterol and triglyceride levels for people with diabetes.
At baseline, mean BMI was 8.6% and mean BMI was 23.3 kg/m², and 4.3% of women and 1.8% of men had obesity.
From baseline through the 2012-2014 cycle, the percentage of participants meeting HbA1c recommendations set by the ADA increased from 9.7% to 25.6% (P < .0001). The percentage of participants prescribed intensive insulin therapy increased during the same period from 5.9% to 64.4% (P < .0001).
“Interestingly, although women were more likely to be on intensive insulin therapy compared with men, the proportion meeting HbA1c recommendations was similar by gender,” the researchers wrote.
The percentage of participants with hypercholesterolemia was high throughout follow-up, and steadily increased from 67.3% to 78.9% (P = .0006), which paralleled a decrease in participants meeting LDL cholesterol targets set by the ADA (falling from 65.7% to 39.7%). Most participants met ADA triglyceride guidelines throughout the course of follow-up, according to researchers, whereas the percentage of participants meeting BP guidelines slightly declined but not significantly (89.7% to 87.4%).
Researchers found that the proportion of participants meeting all ADA guideline recommendations over 25 years rose only slightly, from 6.8% to 7.2% (P = .69). At baseline, 52.4% met three of the four recommendations, falling to one-third by the 2012-2014 cycle. Results did not change when stratified by sex.
“The generally high adherence to blood pressure and triglyceride recommendations remained stable, which suggests these goals may be too lax, supporting other such evidence,” the researchers wrote. “These results illustrate the importance of making patients aware of their blood pressure and lipid profiles, as well as the probable need for stricter recommended targets for adult type 1 diabetes with childhood onset, given continuing high rates despite good blood pressure and triglyceride compliance with current targets.” – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.