Table 4.
Achieving CVD risk targets in T1D.
| Achieving target glycated haemoglobin (HbA1c) in T1D | ||||||||
|---|---|---|---|---|---|---|---|---|
| Study cohort / country of study cohort | Mean age of participants in years (SD) | Mean diabetes duration in years (SD) | Overall number of participants in the study | Number of participants contributing to the risk factor | Target HbA1c defined in the study | Mean BMI (SD), kg/m2 | Results | Reference |
| LAHDCA | 34 (11.9) | 14 (9.0) | 218 | 215 | <7.5% | n/a | Mean (SD) HbA1c was 9.7% (1.9) 17 (8%) had HbA1c <7.5% 126 (59%) had an HbA1c > 9% |
Wallymahmed et al. [2005] |
| CLM | 39.4 (13.5) | 19.4 (10.6) | 1465 | n/a | n/a | n/a | Mean HbA1c was 7.8% | Sastre et al. [2012] |
| 26% had HbA1c ⩽7% | ||||||||
| SRLS | n/a | Median (IQR) 17.5 (9.3–27.0) | 21,789 | 21,290 | <7% | Median BMI 27 | Median HbA1c was 8.5% 13% achieved the target 37% had Hb1Ac ⩾9% |
Livingstone et al. [2012] |
| 19 countries in Australasia, Europe and North America | n/a | n/a | 324,501 | 324,501 | n/a | n/a | 7.1% had HbA1c < 6.5% 8.7% had HbA1c 6.5–6.9% 12.3% had HbA1c 7.0–7.4% |
McKnight et al. [2014] |
| Paediatric cohort | ||||||||
| UHVGPD | 12.5 (3.5) | 4.6 (3.7) | 264 | n/a | <7.5% | 20.4 (3.9) | Mean HbA1c = 7.85% 160 (60.6%) had HbA1c > 7.5%. |
Steigleder-Schweiger et al. [2012] |
| JMRH | 20 (8) | 2.6 (2) | 36 | 36 | n/a | n/a | 33 (91%) had HbA1c > 7% | Tulloch-Reid et al. 2009 |
| NCDQ | 13.1 | 5.7 | 1658 | 1658 | <8.5% in 12 year-olds | 20.2 (3.8) | Mean HbA1c was 8.2% | Margeirsdottir et al. [2008] |
| <8.0% in 6–12 year-olds | 1149 (71.4%) above target level | |||||||
| <7.5% in >12 year-olds | ||||||||
| Older aged cohort | ||||||||
| SRLS | n/a | n/a | 1537 males1427 females | 2964 | <7% | Median BMI 27 in over 60s | Median HbA1c 8.1% (men) and 8.3% (women) in over 60s | Livingstone et al. [2012] |
| Achieving target blood pressure (BP) in T1D | ||||||||
| Study cohort / country of study cohort | Mean age of participants in years (SD) | Mean diabetes duration in years (SD) | Overall number of participants in the study | Number of participants contributing to the risk factor | Target blood pressure defined in the study, mmHg | Mean BMI (SD), kg/m2 | Results | Reference |
| Paediatric cohort | ||||||||
| NCDQ | 13.1 | 5.7 | 1658 | n/a | n/a | 20.2 (3.8) | 152 (6.9%) had BP above the 90th centile | Margeirsdottir et al. [2008] |
| 4% had BP above the 95th percentile | ||||||||
| 0.3% on antihypertensives | ||||||||
| DPV | Range 0.5–26 years | n/a | 27,358 | n/a | n/a | See weight section | 8.1% had systolic hypertension and 2.5% diastolic hypertension | Schwab et al. [2006] |
| 2.1% on anti-hypertensive therapy113 (21%) had arterial hypertension | ||||||||
| LDRDS | n/a | n/a | 539 | n/a | n/a | 13.4% overweight | Dobrovolskien et al. [2013] | |
| Adult cohort | ||||||||
| IEMR | 22.5 (10.3) | n/a | 219 | n/a | <120/80 | n/a | 17 (7.7%) had hypertension | Kalantari et al. [2007] |
| LAHDCA | 34 (11.9) | 14 (9.0) | 218 | 213 | SBP < 135DBP < 85 | n/a | 28 (13%) above target SBP8 (3.8%) above target DBP52 (24%) were taking antihypertensives | Wallymahmed et al. [2005] |
| CLM | 39.4 (13.5) | 19.4 (10.6) | 1465 | n/a | n/a | n/a | 23% were hypertensive | Sastre et al. [2012] |
| SRLS | n/a | 17 | 21,789 | n/a | BP < 130/80 | Median BMI 27 | 60% (men) and 53% (women) were above target BP | Livingstone et al. [2012] |
| 37% aged over 40 had BP ⩾ 140/90 | ||||||||
| Median SBP: 130 mmHg (men) 132 mmHg (women) in age group 40–59 | ||||||||
| EDIC | Year 11 BMI | Nathan et al. [2005] | ||||||
| - Intensive treatment | 45 (7) | 24 (5) | 593 | n/a | 28.4 (6.9) | 38% hypertensive | ||
| - Conventional treatment | 45 (7) | 23 (5) | 589 | n/a | Hypertension defined as: >140/90 | 27.6 (4.5) | 41% hypertensive | |
| EURODIAB | Baseline | |||||||
| - Deceased | 41 (11) | 22 (12) | 102 | n/a | Men: 24.0 (2.9); women:23.5 (3.6) | 56 (55%) hypertensive, 36 (35%) on antihypertensives | Soedamah-Muthu et al. [2008] | |
| - Survived | 32 (10) | 14 (9) | 2685 | n/a | Hypertension defined as: >140/90 mmHg, or on antihypertensives | Men: 23.6 (2.6); women: 23.5 (3.0) | 595 (22%) hypertensive, 225 (8%) on antihypertensives | |
| Older aged cohort | ||||||||
| SRLS | n/a | 17 | 21,789 | n/a | BP < 130/80 | Median BMI 27 for over 60 | Median SBP: 137 mmHg (men) and 138 mmHg (women) for over 60s | Livingstone et al. [2012] |
| 79.5% (men) and 79.4% (women) aged over 60 were on antihypertensives | ||||||||
| Achieving target lipids in T1D | ||||||||
| Study cohort / country of study cohort | Mean age of participants in years (SD) | Mean diabetes duration in years (SD) | Overall number of participants in the study | Number of participants contributing to the risk factor | Target lipids defined in the study | Mean BMI (SD), kg/m2 | Results | Reference |
| CLM | 39.4 (13.5) | 19.4 (10.6) | 1465 | n/a | n/a | n/a | 35% had dyslipidaemia. | Sastre et al. [2012] |
| DPV | n/apaediatric | n/a | 27,358 | 19,359 | n/a | See weight section | 29% had dyslipidaemia 0.4% on lipid lowering treatment |
Schwab et al. [2006] |
| USA | Median 14.3 | 6.4 (3.8) | 46 | n/a | n/a | Baseline BMI 22.8 (3.7) | 50% had dyslipidaemia | Reh et al. [2011] |
| EDIC | Year 11 BMI | Nathan et al. [2005] | ||||||
| - Intensive treatment | 45 (7) | 24 (5) | 593 | n/a | 28.4 (6.9) | 52% hyperlipidaemia, 34% on statin | ||
| - Conventional treatment | 45 (7) | 23 (5) | 589 | n/a | Hyperlipidaemia: defined as LDL >3.4 mmol/l or the use of lipid lowering agent | 27.6 (4.5) | 48% hyperlipidaemia, 33% on statin | |
| Cholesterol | ||||||||
| LDRDS | n/a | n/a | 539 | n/a | n/a | 13.4% overweight | Hypercholesterolemia was diagnosed in 120 (22.3%) | Dobrovolskienė et al. [2013] |
| IEMR | 22.5 (10.3) | n/a | 219 | n/a | Serum cholesterol <170 mg/dl | n/a | Hypercholesterolemia in 104 (47.4%) | Kalantari et al. [2007] |
| LAHDCA | 34 | 14 | 218 | Cholesterol <4.8 mmol/l | n/a | 112 (54.6%) had a total cholesterol above target | Wallymahmed et al. [2005] | |
| SRLS | n/a | Median (IQR) 17.5 (9.3–27.0) | 21,789 | 21,290 | n/a | Median BMI 27 | 41.7% were on a statinMedian cholesterol was 4.4 mmol/l (men) and 4.8 mmol/l (women) in the 40–59 age group | Livingstone et al. [2012] |
| USA | 13.6 (4.1) | 4.5 (0.3) | 360 | 360 | Total cholesterol <200 mg/dl | BMI Z-score 0.62 (1.00) | 16.9% had sustained raised total cholesterol ⩾ 200 mg/dl at follow up | Maahs et al. [2007] |
| LDL | ||||||||
| LDRDS | n/a | n/a | 539 | n/a | n/a | 13.4% overweight | High LDL in 79 (14.7%) | Dobrovolskienė et al. [2013] |
| JMRH | 18 (5) | 3 (2) | 36 | n/a | n/a | n/a | 24 (67%) had high LDL > 2.5 mmol/l | Tulloch-Reid et al. [2009] |
| 12 (33%) had low HDL <1.1 mmol/l | ||||||||
| NCDQ | 13.1 | 5.7 | 1,658 | 1,658 | n/a | 20.2 (3.8) | 453 (34.5%) had LDL > 2.6 mmol/l | Margeirsdottir et al. [2008] |
| Only 0.2% of all the patients or 3% of those who should have been were receiving lipid lowering treatment | ||||||||
| Spain | 37.4 (14.9) | 24.7 (12.2) | 270 | n/a | n/a | 23.2 (3.7) | Mean LDL was 105.06 mg/dl. | Amor et al. [2011] |
| LDL < 100 mg/dl increased from 26.3% in 1999–2000 to 65.9% in 2009–2010. | ||||||||
| HDL | ||||||||
| LDRDS | n/a | n/a | 539 | n/a | n/a | 13.4% overweight | Decreased HDL in 22 (4.1%) | Dobrovolskienė et al. [2013] |
| NCDQ | 13.1 | 5.7 | 1,658 | 1,658 | >1.1 mmol/l | 20.2 (3.8) | 94 (6.9%) had HDL <1.1 mmol/l | Margeirsdottir et al. [2008] |
| IEMR | 22.5 (10.3) | n/a | 219 | n/a | HDL > 35 mg/dl | n/a | HDL<35 mg/dl 22.8% (n = 50) | Kalantari et al. [2007] |
| JMRH | 18 (5) | 3 (2) | 36 | n/a | n/a | n/a | 12 (33%) had low HDL <1.1 mmol/l | Tulloch-Reid et al. [2009] |
| USA | n/a | n/a | 360 | 360 | HDL > 35 mg/dl | BMI Z-score 0.62 (1.00) | 3.3% had HDL <35 mg/dl | Maahs et al. [2007] |
| TG | ||||||||
| LDRDS | n/a | n/a | 539 | n/a | n/a | 13.4% overweight | High TG in 96 (17.8%) | Dobrovolskienė et al. [2013] |
| IEMR | 22.5 (10.3) | n/a | 219 | n/a | TG<150 mg/dl | n/a | Hypertriglyceridemia in 18.3% (n = 40) | Kalantari et al. [2007] |
| UHVGPD | 12.5 (3.5) | 4.6 (3.7) | 264 | n/a | Dyslipidaemia was defined as TG above 95th percentile | 20.4 (3.9) | 60 (22.7%) had raised triglycerides above target. | Steigleder-Schweiger et al. [2012] |
| Older aged cohort | ||||||||
| SRLS | n/a | n/a | Male: 1537Female: 1427 | 2964 | Median BMI 27 | Median cholesterol of 4.0 mmol/l (men) and 4.4 mmol/l (women) aged over 60 Median HDL of 1.4 mmol/l (male) and 1.7 mmol/l (female) aged over 60 Median triglyceride levels of 1.2 mmol/l (male) and 1.1 mmol/l (female) aged over 6072.8% male and 73.6% female over 60 on statins |
Livingstone et al. [2012] | |
| Smoking status in T1D | ||||||||
| Study cohort / country of study cohort | Mean age of participants in years (SD) | Mean diabetes duration in years (SD) | Overall number of participants in the study | Number of participants contributing to the risk factor | Mean BMI (SD), kg/m2 | Results | Reference | |
| IEMR | 22.5 (10.3) | n/a | 219 | n/a | n/a | 15 (6.9%) smoke | Kalantari et al. [2007] | |
| SRLS | n/a | Median (IQR) | 21,789 | 21,290 | Median BMI 27 | 27.6% smoke overall | Livingstone et al. [2012] | |
| 17.5 (9.3–27.0) | ||||||||
| CLM | 39.4 (13.5) | 19.4 (10.6) | 1465 | n/a | n/a | 26% smoke | Sastre et al. [2012] | |
| DPV | 7.5 (2.5) | 2.5 (2.3) | n/a | n/a | 16% BMI > 90th centile | 0.24% smoke | Schwab et al. [2006] | |
| 13.7 (1.4) | 4.9 (3.6) | n/a | 20% BMI > 90th centile | 10.5% smoke | ||||
| 18.5 (2.3) | 8.2 (4.8) | n/a | 25% BMI > 90th centile | 34.8% smoke | ||||
| NCDQ | 13.1 | 5.7 | 1658 | n/a | 20.2 (3.8) | 2% smokeThe mean age of the smokers was 17.4 years. | Margeirsdottir et al. [2008] | |
| FinnDiane | n/a | Gordin et al. [2011] | ||||||
| - With incident CVD event | 39 (12) | n/a | 269 | n/a | 60% had history of smoking | |||
| - No incident CVD event | 38 (13) | n/a | 2698 | n/a | 40% had history of smoking | |||
| EDIC | Year 11 BMI | Nathan et al. [2005] | ||||||
| - Intensive treatment | 45 (7) | 24 (5) | 593 | n/a | 28.4 (6.9) | 14% current smoker at year 11 of EDIC study | ||
| - Conventional treatment | 45 (7) | 23 (5) | 589 | n/a | 27.6 (4.5) | 11% current smoker at year 11 of EDIC study | ||
| EURODIAB | Baseline | Soedamah-Muthu et al. [2008] | ||||||
| - Deceased | 41 (11) | 22 (12) | 102 | n/a | Men: 24.0 (2.9); women:23.5 (3.6) | 32 (31%) current smokers | ||
| - Survived | 32 (10) | 14 (9) | 2685 | n/a | Men: 23.6 (2.6); women: 23.5 (3.0) | 835 (31%) current smokers | ||
| Older aged cohorts | ||||||||
| SRLS | n/a | n/a | Male: 1537Female: 1427 | 2964 | Median BMI 27 for over 60 | 19.1% males and 15.4% females over 60 smoked | Livingstone et al. [2012] | |
| Achieving a healthy diet in T1D | ||||||||
| Study cohort / country of study cohort | Mean age of participants in years (SD) | Mean diabetes duration in years (SD) | Overall number of participants in the study | Number of participants contributing to the risk factor | Target health diet defined in the study | Mean BMI (SD), kg/m2 | Results | Reference |
| NCDQ | 13.1 | 5.7 | 1,658 | Variable – see results | Moderate physical activity >1 hour/dayFat <30% of energyFruit and vegetables >500 g/day | 20.2 (3.8) | 299/576 (51.9%) did moderate physical activity <1 hour/day | Margeirsdottir et al. [2008] |
| 423/518 (82%) had fat >30% of energy intake | ||||||||
| 471/518 (91%) consumed <500 g fruit and vegetables /day | ||||||||
| European | 33 (10) | 15 (9) | 533 | n/a | n/a | Baseline BMI 23.6 (2.7) | European T1D patients consumed a high atherogenic diet.2% achieved the recommended intake of dietary fibre13% achieved the recommended intake of saturated fatThe mean intake of natural dietary fibre was 17.3 g/day | Soedamah-Muthu et al. [2013] |
| 7 year follow up BMI 24.7 (3.2) | ||||||||
| European | n/a | n/a | 3250 | n/a | n/a | n/a | Toeller [2002] | |
| Fibre consumption was lowest in patients from Eastern European centres compared with patients from centres in southern and north-western Europe. The fibre density was highest in patients from southern Europe. |
||||||||
| Achieving target physical activity (PA) levels in T1D | ||||||||
| Study cohort / country of study cohort | Mean age of participants in years (SD) | Mean diabetes duration in years (SD) | Overall number of participants in the study | Number of participants contributing to the risk factor | Target physical activity levels defined in the study | Mean BMI (SD), kg/m2 | Results | Reference |
| European | 32.7 (10.2) | n/a | 3250 | 2185 | n/a | None / mild PA group: 23.4 (2.8) | 786 had none or mild PA once a week or more | Tielemans et al. [2013] |
| Moderate/vigorous PA group: 23.7 (2.8) | 1399 had moderate or vigorous PA once a week or more | |||||||
| Finland | 38.5 (12.3) | 23.4 (12.8) | 1945 | 1108 patients with normoalbuminuria | n/a | 25.1 (3.5) | 23% were sedentary | Wadén et al. [2008] |
| 20.6% less than one session of exercise per week | ||||||||
| Weight, body mass index (BMI) and the ‘metabolic syndrome’ in T1D | ||||||||
| Study cohort / country of study cohort | Mean age of participants in years (SD) | Mean diabetes duration in years (SD) | Overall number of participants in the study | Number of participants contributing to the risk factor | Target BMI defined in the study, kg/m2 | Results | Reference | |
| LDRDS | n/a | n/a | 539 | n/a | n/a | 72 (13.4%) were overweight | Dobrovolskienė et al. [2013] | |
| JMRH | 18 (5) | 3 (2) | 36 | 36 | n/a | 8 (22%) were overweight and 3 (8%) were obese in T1D. | Tulloch-Reid et al. [2009] | |
| NCDQ | 13.1 | 5.7 | 1,658 | 1658 | BMI > 95th percentile defined as obese | 71 (4.4%) were obese | Margeirsdottir et al. [2008] | |
| CLM | 39.4 (13.5) | 19.4 (10.6) | 1465 | n/a | n/a | 15% were obese | Sastre et al. [2012] | |
| UHVGPD | 12.5 (3.5) | 4.6 (3.7) | 264 | n/a | BMI > 90th percentiles = overweight | Mean BMI was 20.4 (3.9)53 (20.1%) had BMI > 90th centile. | Steigleder-Schweiger et al. [2012[ | |
| DPV | 7.5 (2.5) | 2.5 (2.3) | n/a | n/a | n/a | 16.4% had BMI above 90th percentile | Schwab et al. [2006] | |
| 13.7 (1.4) | 4.9 (3.6) | 20.0% had BMI above 90th percentile | ||||||
| 18.5 (2.3) | 8.2 (4.8) | 25.0% had BMI above 90th percentile | ||||||
| EURODIAB | baseline | BMI: mean (SD) | Soedamah-Muthu et al. [2008] | |||||
| - Deceased | 41 (11) | 22 (12) | 102 | n/a | Men: 24.0 (2.9); women:23.5 (3.6) | |||
| - Survived | 32 (10) | 14 (9) | 2685 | n/a | Men: 23.6 (2.6); women: 23.5 (3.0) | |||
| Paediatric Diabetes Consortium | 3 months after diagnosis: 9.7 (3.7) | n/a | 530 | 530 | Baseline median BMI percentile 50%, increasing to 67% at 1 month | Gregg et al. [2015] | ||
| DCCT | Mean (SD) BMI percentile (%) | Baskaran et al. [2015] | ||||||
| - 1999 | 12.2 (2.2) | 2.8 (1.5) | 94 | 94 | 71 (21) | |||
| - 2002 | 12.8 (2.3) | 6.5 (3.5) | 144 | 144 | 72 (21) | |||
| - 2006 | 12.1 (1.9) | 5.7 (3.3) | 133 | 133 | 70 (22) | |||
| - 2009 | 12.7 (2.5) | 6.4 (3.2) | 136 | 136 | 70 (23) | |||
| Ethiopia | 29.1 (12) | n/a | 778 | 778 | Mean BMI increased from 15.9 to 18.3 from 2000 to 2009 | Abebe et al. [2013] | ||
| EDC | Baseline 29.1 | n/a | n/a | 629 | Prevalence at baseline versus at 18years follow up | Conway et al. [2010] | ||
| Obesity: 3.4% versus 22.7% | ||||||||
| Overweight: 28.6% versus 46.0% | ||||||||
| Spain | 39.7 (13.2) | 16.7 (12.9) | 91 | n/a | n/a | 29 (32%) had metabolic syndrome according to the NCEP-ATP III modified criteria | Chillarón et al. [2010] | |
| FinnDiane | 37 (12) | 23 (12) | 3783 | n/a | n/a | Prevalence of metabolic syndrome at baseline was 44% from the FinnDiane study | Thorn et al. [2009] | |
| England | 46 | 21 | 1282 | n/a | n/a | CVD risk factor targets were poorly achieved with only 0.7% of patients achieving all minimal dataset targets. | Syed et al. [2007] | |
| HbA1c and TC targets were those most poorly achieved | ||||||||
| SRLS | n/a | n/a | Male: 1537 | 2964 | n/a | Median BMI in over 60s was 27 | Livingstone et al. [2012] | |
| Female: 1427 | ||||||||
BMI, body mass index; CVD, cardiovascular disease; DBP, diastolic blood pressure; HbA1c, glycated haemoglobin; HDL, high density lipoprotein; IQR, interquartile range; LDL, low density lipoprotein; n/a, not available; NCEP-ATP III, National Cholesterol Education Program-Adult Treatment Panel III; PA, physical activity; SBP, systolic blood pressure; SD, standard deviation; TC, total cholesterol; TG, triglycerides.