Type 1 diabetes goals out of reach for many
medwireNews: Only a minority of individuals with type 1 diabetes from the USA and Europe achieve their glycemic goals, research suggests, with many young patients undertreated for high blood pressure and lipid levels.
The study comparing information on 19,442 individuals with type 1 diabetes from the US Exchange Clinic Network (T1DX) and 28,494 from the German/Austrian Prospective Diabetes Follow-up Registry between 2016 and 2018 demonstrated common treatment gaps despite the geographic differences in care delivery and cardiovascular disease (CVD) management.
“The findings from this large cohort showed that less than 40% of patients with [type 1 diabetes] had optimal glycemic control and only 20% of adults aged less than 26 years were treated for hypertension and dyslipidemia despite indications for treatment,” the researchers report.
“This indicates the need to improve treatment approaches to reduce CVD risk factors in both the USA and Germany/Austria.”
The study participants were 12 years or older and had lived with type 1 diabetes for at least a year. Patients in the US group were significantly more likely to be overweight or obese than those from Europe, and they generally had a longer duration of diabetes and were more likely to use insulin pumps.
European individuals were significantly more likely than those in the USA to achieve glycated hemoglobin (HbA1c) goals, defined according to the ADA as below 7% (58 mmol/mol) for adults aged 18–64 years and below 7.5% (58 mmol/mol) for all others.
However, most patients in both groups fell short of achieving these targets – with just 39% of German/Austrian patients achieving their glycemic target overall versus 21% of those in the USA.
Europeans remained significantly better at hitting glycemic goals than those in the USA when participants were grouped by age, except among those aged over 65 years for whom the converse was true.
Patients in the USA were, however, significantly more likely than European patients to achieve their blood pressure goals, at a corresponding 84% versus 66%, and this was consistent across the age groups.
The same was true for lipid goals, at a respective 73% versus 62%, with this again the case for all the age groups considered.
Men and women from both groups were similarly likely to achieve HbA1c goals, but while optimal control of blood pressure was greater in women, optimal control of lipids was greater in men.
Compared with European patients diagnosed with hypertension or dyslipidemia, those in the USA were more than twice as likely to receive antihypertensive drugs (15 vs 34%) and lipid-lowering medication (11 vs 28%), respectively.
But the use of antihypertensive medications was low in both Europe and the USA overall (11 vs 23%) as was that of lipid-lowering medications (7 vs 22%), particularly for individuals younger than 26 years of age.
Reporting in Diabetes, Obesity, and Metabolism, Viral Shah (University of Colorado Anschutz Medical Campus, Aurora, USA) and co-workers suggest that “more studies are needed to understand the patient and provider related barriers in optimizing diabetes and cardiovascular risk management.”
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