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ABSTRACT
Objective: The mortality rate in people with type 1 diabetes (T1D) is over three-times that of their counterparts without diabetes. The underlying reason for this in the developed world is cardiovascular disease (CVD). Strict control of CVD risk factors, for which guidelines now exist, reduces morbidity and mortality. The objective of this study was to determine if these guidelines are being achieved.
Research design: Data were collected on 1282 adults with T1D from hospitals in the city of Birmingham, UK. Guidelines were those recommended by Joint British Societies: blood pressure (BP) 130/80 mmHg, total cholesterol (TC) 4 mmol/L, non-smoking status, HbA1c 6.5% and body mass index (BMI) 25 kg/m2.
Main outcome measures: The mean age was 46 years and duration of diabetes 21 years. Data on CVD risk factors were poorly documented, with a minimally defined dataset of TC, smoking history and HbA1c being completely recorded in only 72% of people. CVD risk factor targets were also poorly achieved with only 0.7% of patients achieving all minimal dataset targets. HbA1c and TC targets were those most poorly achieved.
Conclusions: This is the largest study of CVD risk factors in the UK and the only one to audit the standard of care provided against recent guidelines published by the joint societies. The results show that CVD risk factors are poorly recorded and sub-optimally managed in adults with T1D. Far more aggressive management is essential if mortality rates for T1D in the UK are to be reduced.