Type 1 diabetes in Cheshire: Cardiometabolic risk factor trends (2004–2009)

Abstract

AimsIn the context of changes in the last 10 years in treatment strategies for type 1 diabetes we evaluated longitudinal trends in cardiometabolic risk factor profiles in a population from North-West England. MethodsWe retrospectively examined longitudinal case records for the period for 291 adult patients followed up between 2004 and 2009 (age range 16–85). Data search was performed through the EMIS® software provider using data held in primary care. ResultsLongitudinal analysis of individually followed patients indicated a mean 0.4% reduction in HbA1c from 8.3% (67mmol/mol) at baseline (p=0.002). The proportion of patients with an HbA1c ≥10% (86mmol/mol) at baseline had a significant reduction over time from 14.0% to 9.5% (χ2=9.4, p=0.002). BMI remained unchanged (28.3 vs 28.4kg/m2). However total cholesterol fell by 12.5% from 4.8mM to 4.2mM, (p<0.0001) with a corresponding 23% reduction in LDL-cholesterol from 3.0mm to 2.3mM (p<0.0001). There was a significant fall in diastolic BP (78–74mmHg, p=0.0016). In a mixed longitudinal regression model, HbA1c was associated with LDL-C (β=0.28, p<0.001) and age (β=0.02, p=0.001), independent of BMI, gender and systolic BP. DiscussionIn spite of intensive work to improve glycaemic control in type 1 diabetes, mean HbA1c remains above target for many people in our area, highlighting the difficulty of achieving glycaemic targets in type 1 diabetes. The significant reduction in diastolic BP, LDL and total cholesterol may have long-term benefit in cardiovascular event rate reduction.