Cardiovasc Diabetol: Changes in cardiovascular disease risk management in patients with type 1 diabetes

Patients with type 1 diabetes mellitus (T1D) who are diagnosed and treated are at increased risk of microvascular and macrovascular disease and have higher
mortality.
Improving cardiovascular (CV) risk factors in patients with T1D is known to reduce diabetes-related cardiovascular complications
.

The study aimed to explore temporal trends
in CV risk factor levels and CV protective treatment patterns.
In addition, the incidence
of diabetes-related CV complications associated with CV-protective treatment exposure was assessed.

The researchers analyzed the records of 41,630 T1D patients enrolled between 1996 and 2017 to obtain CV risk factors (2010-2017), CV-protective drug profiles (1996-2017), and CV complication histories (1977-2017)
from the National Health Registry.

Diabetes-related complication rates based on lipid-lowering and antihypertensive drug use

From 2010 to 2017, HbA1c, LDL-C, and blood pressure levels all declined
.
The proportion of patients with smoking, dysglycaemic disorders (HbA1c≥58 mmol/mol), dyslipidemia (LDL-C>2.
6 mmol/l), and hypertension (≥140/85 mmHg) decreased
.
As of January 1, 2017, one in five people with T1D had severe dysglycemia (HbA1c>75 mmol/mol).

BMI and urine albumin creatinine ratios were slightly elevated, and estimated glomerular filtration rate (eGFR) levels decreased
slightly.

As of January 1, 2017, one-quarter of T1D patients had an eGFR < 60 ml/min/1.
73 m2
.
The proportion of patients with T1D who use lipid-lowering drugs (LLDs) increased from 5% in 2000 to 30% in 2010, then plateaued and then declined
.
The proportion of patients with T1D who purchase antihypertensive drugs (AHDs) increased from 28% in 1996 to 42% in 2010 and has since
declined.
The use of LLD is associated with a lower incidence of microvascular and macrovascular complications; AHD use was associated with higher rates of CVD and CKD, respectively, compared with
no and no use of AHD.

In summary, control of CV risk factors improved in patients with T1D in Denmark between 2010 and 2017
.
However, there is a clear gap
between current clinical guidelines and the clinical practice of CV risk management in patients with T1D.
Action is needed to drive further improvements in cardiovascular disease risk control to reduce cardiovascular disease and associated excessive mortality
.

Original source:

Amadid, H.
, Clemmensen, K.
K.
B.
, Vistisen, D.
et al.
Time trends of cardiovascular risk management in type 1 diabetes - nationwide analyses of real-life data.
Cardiovasc Diabetol 21, 255 (2022).
https://doi.
org/10.
1186/s12933-022-01692-5