Table 3.

Summary of CVD risk factor screening and treatment in T1DM

Risk factor	Screening test	Timing	Target	Actions to be considered	Professional organization recommendation
Hyperglycemia	HbA1c, glucose monitoring	Every 3 mo	Adults: ≤7.0%; youth: age 13–19 y, <7.5%; age 6–12 y, <8.0%; age <6 y, <8.5%	Increased intensity of glucose monitoring and manipulation of insulin dosing	ADA
DKD	Urine albumin to creatinine ratio; estimated GFR	Yearly beginning 5 y after diagnosis		ACE inhibitor; keep BP <130/80 mmHg (adults) or <90th percentile (children)	ADA, NKF
Dyslipidemia	Fasting lipid profile	Adults: every 2 y if low-risk values	LDL <100 mg/dL; non–HDL-C <130 mg/dL	Optimize glycemic control; low saturated fat diet; optimize other CVD risk factors	NHLBI (ATP III and Integrated Pediatric Guidelines*), ADA, AAP, AHA
	Fasting lipid profile	Children aged 10–21 y, once every 3–5 y	LDL <100 mg/dL; non–HDL-C <130 mg/dL	Consider statins if LDL ≥100 mg/dL, recommended if LDL ≥160 mg/dL; once treated, LDL goal is <100–130 mg/dL	NHLBI (ATP III, Integrated Guidelines*), AAP, AHA
	Fasting lipid profile	Adults without CVD	LDL <100 mg/dL	Statins, goal LDL <100 mg/dL	NHLBI (ATP III), ADA
	Fasting lipid profile	Adults with CVD	LDL <70 mg/dL	Statins, goal LDL <70 mg/dL	NHLBI (ATP III), ADA
Hypertension	BP	Every visit	Adults: >140/80 mmHg, goal <130/80 mmHg; children: BP >95th percentile or >130/80 mmHg	Lifestyle modifications for those with BP >120/80 mmHg: low salt, high fruits and vegetables, regular exercise	NHLBI (JNC 7), ADA
				Medications for those with BP >140/80 mmHg, or 130/80 mmHg in some younger individuals: ACE or ARB inhibitor, add others as necessary to achieve normal BP
Prehypertension	BP	Every visit	Adults: 120–130/80–89 mmHg; children: BP 90th–95th percentile	Borderline BP: low salt, high fruits and vegetables; regular exercise	ADA
Thrombosis prevention	None	Age ≥21 y	Adults with CVD	Aspirin	NHLBI (ATP III)

AAP, American Academy of Pediatrics; ACE, angiotensin-converting enzyme; ADA, American Diabetes Association; AHA, American Heart Association; ARB, angiotensin receptor blocker; ATP III, Adult Treatment Panel III; BP, blood pressure; CVD, cardiovascular disease; DKD, diabetic kidney disease; GFR, glomerular filtration rate; HbA_1c, hemoglobin A_1c; HDL-C, high-density lipoprotein cholesterol; JNC, Joint National Committee; LDL, low-density lipoprotein; mo, month; NHLBI, National Heart, Lung, and Blood Institute; NKF, National Kidney Foundation; T1DM, type 1 diabetes mellitus; y, year.

^*Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents (125).