Lipid and Blood Pressure Treatment Goals for Type 1 Diabetes
10-year incidence data from the Pittsburgh Epidemiology of Diabetes Complications Study
- Trevor J. Orchard, MBBCH, MMEDSCI1,
- Kimberly Y.-Z. Forrest, PHD2,
- Lewis H. Kuller, MD1 and
- Dorothy J. Becker, MBBCH3
- 1Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
- 2Department of Allied Health, Slippery Rock University of Pennsylvania, Slippery Rock, Pennsylvania
- 3Department of Pediatrics, Endocrinology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
OBJECTIVE—Subjects with type 1 diabetes are at high risk for many long-term complications, including early mortality and coronary artery disease (CAD). Few data are available on which to base goal levels for two major risk factors, namely blood pressure and lipid/lipoproteins. The objective of this study was to determine at which levels of LDL and HDL cholesterol, triglycerides, and blood pressure the relative risks of type 1 diabetic complications increase significantly.
RESEARCH DESIGN AND METHODS—Observational prospective study of 589 patients with childhood-onset type 1 diabetes (<17 years) aged ≥18 years at baseline; 10-year incidence of mortality, CAD, lower-extremity arterial disease, proliferative retinopathy, distal symmetric polyneuropathy, and overt nephropathy. Relative risks were determined using traditional groupings of blood pressure and lipid/lipoproteins, measured at baseline, using the lowest groupings (<100 mg/dl [2.6 mmol/l] LDL cholesterol, <45 mg/dl [1.1 mmol/l] HDL cholesterol, <100 mg/dl [1.1 mmol/l] triglycerides, <110 mmHg systolic blood pressure, and <80 mmHg diastolic blood pressure) as reference. Adjustments for age, sex, and glycemic control were examined.
RESULTS—Driven mainly by strong relationships (RR range 1.8–12.1) with mortality, CAD, and overt nephropathy, suggested goal levels are as follows: LDL cholesterol <100 mg/dl (2.6 mmol/l), HDL cholesterol >45 mg/dl (1.1 mmol/l), triglycerides <150 mg/dl (1.7 mmol/l), systolic blood pressure <120 mmHg, and diastolic blood pressure <80 mmHg. Age, sex, and glycemic control had little influence on these goals.
CONCLUSIONS—Although observational in nature, these data strongly support the case for vigorous control of lipid levels and blood pressure in patients with type 1 diabetes.
- ADA, American Diabetes Association
- CAD, coronary artery disease
- DCCT, Diabetes Control and Complications Trial
- DSP, distal symmetric polyneuropathy
- EDC, Pittsburgh Epidemiology of Diabetes Complications Study
- LEAD, lower extremity arterial disease
- ON, overt nephropathy
- PR, proliferative retinopathy
- RR, relative risk
Address correspondence and reprint requests to Trevor J. Orchard, MD, University of Pittsburgh, DLR Building, 3512 Fifth Avenue, Pittsburgh, PA 15213. E-mail:.
Received for publication 21 November 2000 and accepted in revised form 22 February 2001.
T.J.O. has received research support from Merck, has served as a consultant to Merck, Schering Plough, and Bayer within the past year, is a minor stockholder of Bristol Myers Squibb, and has received speaking honoraria from SmithKline Beecham and Bayer.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.