Vascular risk factors in patients with type 1 diabetes

Type 1 diabetes results from beta cell destruction and accounts for approximately 10% of all diabetes worldwide. Life expectancy is reduced with renal and cardiovascular disease accounting for the majority of deaths after the age of 30 years. The development of micro- and macrovascular complications is promoted by poor glycaemic control, hypertension and hyperlipidaemia and targets to reduce these risk factors have been set. The aim of this study was to assess the achievement of risk factor targets in people with type 1 diabetes attending a routine hospital based diabetic clinic. We have audited the case notes of 218 patients with type 1 diabetes who attended a consultant led diabetic clinic over a six-month period. One hundred and nine (50%) patients were male, mean age was 34 years (range 16-72 years), and mean duration of diabetes was 14 years (range 0.5-40 years). Only 17 (7.9%) patients had an HbA1c <7.5%, 112 (54.6%) had a total cholesterol above target (>4.8mmoVL), 28 (13.1%) had a systolic blood pressure above target (>135mmHg) and eight (3.8%) had a diastolic blood pressure above target (>85mmHg). There was a positive correlation between HbA1c and total cholesterol (r=0.24, p<0.01). Many of these patients with type 1 diabetes have micro- and macrovascular risk factors outside desirable ranges, particularly for glycaemic control and lipid levels. To reduce the long-term complications associated with diabetes, improving glycaemic control remains a challenge and increased usage of lipid lowering agents is indicated.