Lipid and blood pressure treatment goals for type 1 diabetes: 10-year incidence data from the Pittsburgh Epidemiology of Diabetes Complications Study.
OBJECTIVE
Subjects with type 1 diabetes are at high risk for many long-term complications, including early mortality and coronary artery disease (CAD). Few data are available on which to base goal levels for two major risk factors, namely blood pressure and lipid/lipoproteins. The objective of this study was to determine at which levels of LDL and HDL cholesterol, triglycerides, and blood pressure the relative risks of type 1 diabetic complications increase significantly.


METHODS
Observational prospective study of 589 patients with childhood-onset type 1 diabetes (<17 years) aged > or =18 years at baseline; 10-year incidence of mortality, CAD, lower-extremity arterial disease, proliferative retinopathy, distal symmetric polyneuropathy, and overt nephropathy. Relative risks were determined using traditional groupings of blood pressure and lipid/lipoproteins, measured at baseline, using the lowest groupings (<100 mg/dl [2.6 mmol/l] LDL cholesterol, <45 mg/dl [1.1 mmol/l] HDL cholesterol, <100 mg/dl [1.1 mmol/l] triglycerides, <110 mmHg systolic blood pressure, and <80 mmHg diastolic blood pressure) as reference. Adjustments for age, sex, and glycemic control were examined.


RESULTS
Driven mainly by strong relationships (RR range 1.8-12.1) with mortality, CAD, and overt nephropathy, suggested goal levels are as follows: LDL cholesterol <100 mg/dl (2.6 mmol/l), HDL cholesterol >45 mg/dl (1.1 mmol/l), triglycerides <150 mg/dl (1.7 mmol/l), systolic blood pressure <120 mmHg, and diastolic blood pressure <80 mmHG: Age, sex, and glycemic control had little influence on these goals.


CONCLUSIONS
Although observational in nature, these data strongly support the case for vigorous control of lipid levels and blood pressure in patients with type 1 diabetes.
Orchard
T J
TJ
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 3512 Fifth Avenue, Pittsburgh, PA 15213, USA. tjo@pitt.edu
Forrest
K Y
KY
Kuller
L H
LH
Becker
D J
DJ
D000328:Adult; D001794:Blood Pressure / Q000502:physiology*; D008076:Cholesterol, HDL / Q000097:blood; D015331:Cohort Studies; D003327:Coronary Disease / Q000453:epidemiology* / Q000401:mortality; D003922:Diabetes Mellitus, Type 1 / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000453:epidemiology* / Q000401:mortality; D003928:Diabetic Nephropathies / Q000453:epidemiology / Q000401:mortality; D003929:Diabetic Neuropathies / Q000453:epidemiology* / Q000401:mortality; D003930:Diabetic Retinopathy / Q000453:epidemiology* / Q000401:mortality; D003971:Diastole; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D015994:Incidence; D008297:Male; D010414:Pennsylvania / Q000453:epidemiology; D016016:Proportional Hazards Models; D012306:Risk; D012307:Risk Factors; D013599:Systole; D014280:Triglycerides / Q000097:blood
D008076:Cholesterol, HDL; D006442:Glycated Hemoglobin; D014280:Triglycerides