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The consequences of failure to achieve targets of guidelines for prevention and treatment of diabetic complications in patients with type 1 diabetes

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Abstract

To study how the targets of glycemic, blood pressure (BP) and lipid control based on the American Diabetes Association (ADA) guidelines have been implemented, and to assess the risk of cardiovascular events (CVD) and mortality in patients with type 1 diabetes stratified by nephropathy (DN) status. A nationally representative cohort of patients with type 1 diabetes (N = 3,151) from the FinnDiane Study were included. CVD and deaths were identified from the national registers. The treatment targets were HbA1C <7 %, BP <140/80 mmHg and LDL cholesterol <2.6 mmol/l. About 63 % of the patients with DN and 34 % of the patients without DN reached none of the targets. With DN, the 10-year cumulative risk of CVD was 17.4 % (95 % CI 11.1–23.2) if BP was on target, 29.9 % (23.0–36.2, P = 0.03) if BP was not on target and 28.4 % (24.9–31.8, P = 0.009) in those who reached none of the targets. The corresponding figures were 3.8 % (2.7–4.8), 4.4 % (2.7–6.2, P = 0.3) and 8.1 % (6.4–9.8, P < 0.0001) for those without DN. In those with DN, the risk of CVD was higher if BP was not on target [hazard ratio (HR) 1.9 (1.1–3.3)], or none of the three targets [HR 2.2 (1.4–3.6)] were reached than if BP was on target. Although the risk of death without DN was higher in those who reached none of the targets (P = 0.003), after adjustment, no differences were observed between the groups. Failure to reach ADA treatment targets is associated with increased risk of mortality and CVD in patients with type 1 diabetes.

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Acknowledgments

This research was supported by grants from the Folkhälsan Research Foundation, the Wilhelm and Else Stockmann Foundation, Academy of Finland and the “Liv och Häls” Foundation and The Diabetes Research Foundation. The authors also acknowledge the physicians and nurses at each study center (Supplementary Appendix 1).

Conflict of interest

P.-H. G. has received lecture honorary honorariums from Boehringer Ingelheim, Genzyme, Novartis, Novo Nordisk, MSD, Eli Lilly and Medscape. P.-H. G. is an advisory board member for Boehringer Ingelheim, Eli Lily, Novartis, Abbott and Abbvie. P.-H. G. has received investigator-initiated study grants from Eli Lilly and Roche. M. S. has received lecture fees from Eli Lilly, Medtronic, Novo Nordisk, Roche and Sanofi-Aventis and is an advisory board member of Medtronic in Scandinavia. No other potential conflicts of interest relevant to this article were reported. The funding sources were not involved in the design or conduct of the study.

Human and animal rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

Informed consent

Informed consent was obtained from all patients for being included in the study.

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Authors and Affiliations

  1. Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki University, Haartmaninkatu 8 (C318b), PO Box 63, 00014, Helsinki, Finland

    Raija Lithovius, Valma Harjutsalo, Carol Forsblom, Markku Saraheimo & Per-Henrik Groop

  2. Division of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland

    Raija Lithovius, Valma Harjutsalo, Carol Forsblom, Markku Saraheimo & Per-Henrik Groop

  3. Research Program Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland

    Raija Lithovius, Valma Harjutsalo, Carol Forsblom, Markku Saraheimo & Per-Henrik Groop

  4. Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland

    Valma Harjutsalo

  5. Baker IDI Heart and Diabetes Institute, Melbourne, Australia

    Per-Henrik Groop

Authors
  1. Raija Lithovius
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  2. Valma Harjutsalo
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  3. Carol Forsblom
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  4. Markku Saraheimo
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  5. Per-Henrik Groop
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Correspondence to Per-Henrik Groop.

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Lithovius, R., Harjutsalo, V., Forsblom, C. et al. The consequences of failure to achieve targets of guidelines for prevention and treatment of diabetic complications in patients with type 1 diabetes. Acta Diabetol 52, 31–38 (2015). https://doi.org/10.1007/s00592-014-0595-x

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  • DOI: https://doi.org/10.1007/s00592-014-0595-x

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