Danish study: Control of cardiovascular risks in type 1 diabetes improved

Erkenntnis

• In the last decade, an encouraging improvement in cardiovascular Risk factors in patients with type 1 diabetes (T1D) in Denmark.
• But only a minority meet national and international treatment targets for HbA1c, BD and Low-density lipoprotein(LDL) cholesterol.
• The use of lipid-lowering drugs (LLDs) and antihypertensive drugs (AHDs) decreased after 2012.
• Physicians should pay more attention and a more aggressive attitude toward cardiovascular risk management in T1D patients.

Why this matters

• T1D patients have an almost three times higher mortality rate compared to the general population, mainly due to the early development of cardiovascular disease.
• The incidence of cardiovascular disease is at least as high in T1D as in type 2 diabetes, but management of cardiovascular risk factors is typically less aggressive due to the lack of T1D-specific data, less clear guidelines, and management largely focused on glycemia.

Study design

• Researchers investigated the temporal evolution of cardiovascular risk factors and patterns of cardiovascular protective treatments, as well as the incidence rates of diabetes-related cardiovascular complications depending on exposure to protective treatment.
• Data sets from 41,630 T1D patients registered in a nationwide Danish diabetes registry between 1996 and 2017 were analysed.
• Data were collected from other nationwide health registries on the determination of cardiovascular risk factors (2010–2017), the profile of the prescription of cardiovascular drugs (1996–2017), and the course of cardiovascular complications (1977–2017).
• Funding: Sanofi-Aventis

Key results

• Between 2010 and 2017, improvements in cardiovascular risk factor control were observed in T1D patients in Denmark.
• HbA1c, LDL-C and BD levels decreased from 2010 to 2017, with lower proportions of smokers and those with glycemic dysregulation, dyslipidemia and hypertension.
• To 1.  However, in January 2017, one-fifth of the T1D population had severe glycemic dysregulation.
• From 2010 to 2017, slight increases in BMI rates of> 25 kg/m2 (overweight/obesity) and urinary albumin-creatinine ratios of ≥ 30 mg/g (albuminuria) and a slight decrease in the estimated glomerular filtration rate (eGFR, impaired renal function) were observed.
• To 1.  In January 2017, a quarter of the T1D population had an eGFR of <60 ml/minute/1.73 m2 and 54 % were overweight/obese.
• The proportion of LLD treatments increased from  5 % in 2000 to 30 % in 2010, then remained the same and then decreased.
• The proportion of AHD treatments increased from  28 % in 1996 to 42 % in 2010, followed by a decrease.
• Rates of dyslipidemia and hypertension were higher in non-users of LLDs and AHDs than in users, and most CV complication rates were higher in non-users and former users of both classes of drugs.

Restrictions

• Laboratory measurements only available since year 2010.
• Reason for non-utilization, i.e.no regulation or unfulfilled regulations, is not recognizable.

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