Aims/hypothesis: Optimal diabetes care and risk factor management are important to delay micro- and macrovascular complications in individuals with type 1 diabetes (T1D). Ongoing improvement of management strategies requires the evaluation of target achievement and identification of risk factors in individuals who do (or do not) achieve these targets.
Methods: Cross-sectional data were collected from adults with T1D visiting six diabetes centers in the Netherlands in 2018. Targets were defined as glycated hemoglobin (HbA1c) <53 mmol/mol, low-density lipoprotein-cholesterol (LDL-c) <2.6 mmoL/L (no cardiovascular disease [CVD] present) or <1.8 mmoL/L (CVD present), or blood pressure (BP) <140/90 mm Hg. Target achievement was compared for individuals with and without CVD.
Results: Data from 1737 individuals were included. Mean HbA1c was 63 mmol/mol (7.9%), LDL-c was 2.67 mmoL/L, and BP 131/76 mm Hg. In individuals with CVD, 24%, 33%, and 46% achieved HbA1c, LDL-c, and BP targets respectively. In individuals without CVD these percentages were 29%, 54%, and 77%, respectively. Individuals with CVD did not have any significant risk factors for HbA1c, LDL-c, and BP target achievement. In comparison, individuals without CVD were more likely to achieve glycemic targets if they were men and insulin pump users. Smoking, microvascular complications, and the prescription of lipid-lowering and antihypertensive medication were negatively associated with glycemic target achievement. No characteristics were associated with LDL-c target achievement. Microvascular complications and antihypertensive medication prescription were negatively associated with BP target attainment.
Conclusion: Opportunities for improvement of diabetes management exist for the achievement of glycemic, lipid, and BP targets but may differ between individuals with and without CVD.
目的: 最佳的糖尿病护理和危险因素管理对于延缓1型糖尿病(T1D)患者的微血管和大血管并发症非常重要。管理战略的持续改进需要对目标实现情况进行评估, 并确定实现(或未实现)这些目标的个人风险因素。 方法: 于2018年收集了荷兰六个糖尿病中心成年T1D患者的横断面数据。目标定义为HbA1c <53mmol/mol、低密度脂蛋白胆固醇(LDL-C)<2.6mmol/l(无心血管疾病(CVD)存在)或<1.8mmol/l(存在CVD), 或血压(BP)<140/90mmHg。比较了有无CVD的个体的目标达成情况。 结果: 纳入了1737人的数据。平均HbA1c 为63 mmol/mol (7.9%), LDL-C为2.67 mmol/l, BP 为131/76 mmHg。在CVD患者中, 分别有24%、33%和46%达到了HbA1c 、LDL-C和BP目标。在没有心血管疾病的个体中, 这些比例分别为29%、54%和77%。CVD患者在HbA1c 、LDL-C和BP目标实现方面没有任何显著的危险因素。相比之下, 没有心血管疾病的人更有可能达到血糖目标, 如果他们是男性和胰岛素泵使用者。吸烟、微血管并发症、降脂处方和降压药与实现血糖目标呈负相关。没有与LDL-C目标实现相关的特征。微血管并发症和抗高血压药物处方与血压达标呈负相关。 结论: 改善糖尿病管理的机会存在于实现血糖、血脂和血压的达标, 但可能在有和没有CVD的个体之间有所不同。.
Keywords: 1型糖尿病; LDL; LDL。; blood glucose; blood pressure; cardiovascular diseases; cholesterol; diabetes mellitus type 1; lipid metabolism; 心血管疾病; 胆固醇; 脂代谢; 血压; 血糖.
© 2023 The Authors. Journal of Diabetes published by Ruijin Hospital, Shanghai JiaoTong University School of Medicine and John Wiley & Sons Australia, Ltd.