title: Type 1 diabetes in Cheshire: cardiometabolic risk factor trends (2004-2009).
abstract: OBJECTIVE
  In the context of changes in the last 10 years in treatment strategies for type 1 diabetes we evaluated longitudinal trends in cardiometabolic risk factor profiles in a population from North-West England.
  
  
  METHODS
  We retrospectively examined longitudinal case records for the period for 291 adult patients followed up between 2004 and 2009 (age range 16-85). Data search was performed through the EMIS® software provider using data held in primary care.
  
  
  RESULTS
  Longitudinal analysis of individually followed patients indicated a mean 0.4% reduction in HbA1c from 8.3% (67 mmol/mol) at baseline (p=0.002). The proportion of patients with an HbA1c ≥10% (86 mmol/mol) at baseline had a significant reduction over time from 14.0% to 9.5% (χ(2)=9.4, p=0.002). BMI remained unchanged (28.3 vs 28.4 kg/m(2)). However total cholesterol fell by 12.5% from 4.8mM to 4.2mM, (p<0.0001) with a corresponding 23% reduction in LDL-cholesterol from 3.0mm to 2.3mM (p<0.0001). There was a significant fall in diastolic BP (78-74 mmHg, p=0.0016). In a mixed longitudinal regression model, HbA1c was associated with LDL-C (β=0.28, p<0.001) and age (β=0.02, p=0.001), independent of BMI, gender and systolic BP.
  
  
  CONCLUSIONS
  In spite of intensive work to improve glycaemic control in type 1 diabetes, mean HbA1c remains above target for many people in our area, highlighting the difficulty of achieving glycaemic targets in type 1 diabetes. The significant reduction in diastolic BP, LDL and total cholesterol may have long-term benefit in cardiovascular event rate reduction.
authors.affiliation: Cardiovascular Sciences Research Group, Core Technology Facility, The University of Manchester, Grafton Street, Manchester, United Kingdom.
authors.forename: Simon G
authors.initials: SG
authors.lastname: Anderson
authors.forename: Ram P
authors.initials: RP
authors.lastname: Narayanan
authors.forename: Jehad
authors.initials: J
authors.lastname: Amlesh
authors.forename: Mohammad Z
authors.initials: MZ
authors.lastname: Qureshi
authors.forename: Adrian Hugh
authors.initials: AH
authors.lastname: Heald
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D015992:Body Mass Index; D016009:Chi-Square Distribution; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D004739:England / Q000453:epidemiology; D006442:Glycated Hemoglobin / Q000378:metabolism; D019983:Guideline Adherence; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008137:Longitudinal Studies; D024821:Metabolic Syndrome / Q000097:blood / Q000453:epidemiology* / Q000503:physiopathology; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014280:Triglycerides / Q000097:blood; D055815:Young Adult
chemical_list: D015415:Biomarkers; D002784:Cholesterol; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D014280:Triglycerides; C517652:hemoglobin A1c protein, human