Achievement of cardiovascular risk factor targets in young adults with diabetes mellitus

Figures & data

Table 1 Process and outcome parameters assessed based upon American Diabetes Association guidelines

Parameter	Treatment target assessed
HbA1c	< 7%
Blood pressure	Recorded at every visit < 130/80 mmHg
Dyslipidemia	In individuals without overt cardiovascular disease LDL ≤2.6 mmol/L For those aged over 40 years, statin therapy to achieve an LDL reduction of 30%–40% regardless of baseline LDL levels is recommended For those younger than 40 years, but at increased risk due to other cardiovascular risk factors who do not achieve lipid goals with lifestyle modifications alone, the addition of pharmacological therapy is appropriate
	In individuals with overt CVD Statin therapy where not otherwise contraindicated triglycerides 1.7 mmol/L and raise HDL cholesterol to >1.0 mmol/L in men and >1.3 mmol/L in women
Antiplatelet therapy	Secondary prevention in diabetic individuals with history of CVD
	Primary prevention strategy in those with type 1 or type 2 diabetes at increased cardiovascular risk, including those who are older than 40 years or who have additional risk factors (family history of cardiovascular disease, hypertension, smoking, dyslipidemia, or albuminuria)
Nephropathy	Annual screening for microalbuminuria
	Appropriate treatment with angiotensin-converting enzyme inhibitor or angiotensin 2 receptor blocker
Retinopathy	Screening at least every 2 years
Neuropathy	Annual screening for distal symmetric polyneuropathy
	Screening for autonomic neuropathy with symptoms and signs annually
Smoking	Documentation about smoking habits
	Advice given about cessation (if appropriate)

Abbreviations: CVD, cardiovascular disease; HDL, high-density lipoprotein; LDL, low-density lipoprotein.

Table 2 Demographics and glycemic control in patients with type 1 and type 2 diabetes

	Type 1 DM	Type 2 DM	P
Number of patients	154	42
Weight (mean ± SD) (kg)	78.7 ± 17.9	93.6 ± 27.2	< 0.001
Age (mean ± SD) (years)	29.5 ± 16.1	39.6 ± 8.0	< 0.001
Gender (% males)	48	31	< 0.001
HbA1c (mean ± SD) (%)	8.33 ± 1.35	8.13 ± 2.01	0.44
Achieving HbA1c < 7% (ratio and %)	19/154 (12)	13/42 (31)	< 0.001

Abbreviations: DM, diabetes mellitus; HbA_1c, glycosylated hemoglobin; SD, standard deviation.

Table 3 Comparison of treatment and outcome measures in patients with type 1 and type 2 diabetes

	Type 1 DM Number (%)	Type 2 DM Number (%)	P
Macrovascular risk factor modification targets
Process measures
Blood pressure documented	131/154 (85)	40/42 (95)	0.372
Lipid profile documented	44/154 (29)	27/42 (64)	< 0.001
Antiplatelet therapy indication	62/154 (40)	31/42 (74)	< 0.001
Appropriate prescription of antiplatelet therapy	3/62 (4.8)	6/34 (18)	< 0.001
Indication for lipid-lowering therapy	40/154 (26)	27/42 (64)	< 0.001
Appropriate prescription of lipid-lowering therapy	12/40 (30)	11/27 (41)	< 0.001
Outcome measures
Target blood pressure < 130/80	80/131 (61)	18/40 (45)	0.210
Blood pressure ≤ 140/90	124/131 (95)	39/40 (98)	0.505
C ombined lipids target (LDL < 2.6 mmol/L, H DL >1.0 mmol/L, triglycerides < 1.7 mmol/L)	7/44 (16)	10/27 (28)	0.066
LDL < 2.6 mmol/L	15/33 (45)	13/26 (50)	0.508
Microvascular complication and screening
Patients screened for nephropathy	86/139 (62)	24/37 (65)	0.889
Patients with nephropathy	15/154 (9.7)	5/42 (12)	0.831
ACE inhibitor/AR2B prescribed for microalbuminuria/nephropathy	11/15 (73)	4/5 (80)	0.422
Patients screened for retinopathy	96/127 (76)	25/35 (71)	0.104
Patients with known retinopathy	27/154 (18)	7/42 (17)	0.104
Patients with peripheral neuropathy	10/154 (6.5)	8/42 (19)	0.040
Screened for peripheral neuropathy	135/154 (88)	32/42 (76)	0.041

Abbreviations: ACE, angiotensin-converting enzyme; AR2B, angiotensin 2 receptor blocker; DM, diabetes mellitus; HDL, high-density lipoprotein; LDL, low-density lipoprotein.

Table 4 Comparison of demographics and treatment outcomes in patients younger or older than 25 years

	Age ≤25 years	Age >25 years	P
Age at time of visit (years)	21.6 ± 2.0	36.0 ± 7.8	< 0.001
Weight (kg)	77.6 ± 14.9	79.6 ± 20.0	0.015
HbA1c (%)	8.60 ± 1.56	8.13 ± 1.14	0.007
Blood pressure systolic (mmHg)	113.2 ± 15.2	118.4 ± 16.9	0.424
Blood pressure diastolic (mmHg)	67.7 ± 10.0	73.3 ± 10.0	0.987
LDL (mmol/L)	2.60 ± 0.88	2.80 ± 0.87	0.938
HDL (mmol/L)	1.70 ± 1.04	1.41 ± 0.33	< 0.001
Triglycerides (mmol/L)	1.79 ± 1.68	1.28 ± 0.69	< 0.001

Notes: Data are presented as mean standard ± deviation. P values measured by unpaired t-test.

Abbreviations: HbA_1c, glycosylated hemoglobin; HDL, high-density lipoprotein; LDL, low-density lipoprotein.

Table 5 Comparison of macrovascular risk factor modification in patients younger or older than 25 years

	Age ≤25 years Number (%)	Age >25 Number (%)	P
Process measures
Indication for lipid-lowering therapy	10/70 (14.3)	57/132 (43.1)	< 0.001
Appropriate prescription of lipid-lowering therapy	1/10 (10)	22/52 (42.3)	< 0.001
Indication for antiplatelet therapy	18/69 (26.1)	78/132 (59.1)	< 0.001
Appropriate prescription of antiplatelet therapy	0/18 (0)	9/71 (12.7)	< 0.001
Current smoker	6/26 (23.1)	16/55 (29.1)	0.620
Appropriate smoking cessation advice given	0/26 (0)	9/17 (52.9)	0.017
Outcome measures
Combined blood pressure targets	43/70 (61.5)	58/132 (44.0)	0.026
Combined lipid targets	3/67 (4.5)	17/132 (12.9)	0.080