The consequences of failure to achieve targets of guidelines for prevention and treatment of diabetic complications in patients with type 1 diabetes.
To study how the targets of glycemic, blood pressure (BP) and lipid control based on the American Diabetes Association (ADA) guidelines have been implemented, and to assess the risk of cardiovascular events (CVD) and mortality in patients with type 1 diabetes stratified by nephropathy (DN) status. A nationally representative cohort of patients with type 1 diabetes (N = 3,151) from the FinnDiane Study were included. CVD and deaths were identified from the national registers. The treatment targets were HbA1C <7 %, BP <140/80 mmHg and LDL cholesterol <2.6 mmol/l. About 63 % of the patients with DN and 34 % of the patients without DN reached none of the targets. With DN, the 10-year cumulative risk of CVD was 17.4 % (95 % CI 11.1-23.2) if BP was on target, 29.9 % (23.0-36.2, P = 0.03) if BP was not on target and 28.4 % (24.9-31.8, P = 0.009) in those who reached none of the targets. The corresponding figures were 3.8 % (2.7-4.8), 4.4 % (2.7-6.2, P = 0.3) and 8.1 % (6.4-9.8, P < 0.0001) for those without DN. In those with DN, the risk of CVD was higher if BP was not on target [hazard ratio (HR) 1.9 (1.1-3.3)], or none of the three targets [HR 2.2 (1.4-3.6)] were reached than if BP was on target. Although the risk of death without DN was higher in those who reached none of the targets (P = 0.003), after adjustment, no differences were observed between the groups. Failure to reach ADA treatment targets is associated with increased risk of mortality and CVD in patients with type 1 diabetes.
Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki University, Haartmaninkatu 8 (C318b), PO Box 63, 00014, Helsinki, Finland.
Raija
R
Lithovius
Valma
V
Harjutsalo
Carol
C
Forsblom
Markku
M
Saraheimo
Per-Henrik
PH
Groop
D000328:Adult; D000368:Aged; D000574:American Medical Association; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D008078:Cholesterol, LDL / Q000378:metabolism; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000188:drug therapy / Q000378:metabolism; D005387:Finland; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D014481:United States; D055815:Young Adult
D001786:Blood Glucose; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human