Table 3

Summary of CVD risk factor screening and treatment in T1DM

Risk factorScreening testTimingTargetActions to be consideredProfessional organization recommendation
HyperglycemiaHbA1c, glucose monitoringEvery 3 moAdults: ≤7.0%; youth: age 13–19 y, <7.5%; age 6–12 y, <8.0%; age <6 y, <8.5%Increased intensity of glucose monitoring and manipulation of insulin dosingADA
DKDUrine albumin to creatinine ratio; estimated GFRYearly beginning 5 y after diagnosisACE inhibitor; keep BP <130/80 mmHg (adults) or <90th percentile (children)ADA, NKF
DyslipidemiaFasting lipid profileAdults: every 2 y if low-risk valuesLDL <100 mg/dL; non–HDL-C <130 mg/dLOptimize glycemic control; low saturated fat diet; optimize other CVD risk factorsNHLBI (ATP III and Integrated Pediatric Guidelines*), ADA, AAP, AHA
Fasting lipid profileChildren aged 10–21 y, once every 3–5 yLDL <100 mg/dL; non–HDL-C <130 mg/dLConsider statins if LDL ≥100 mg/dL, recommended if LDL ≥160 mg/dL; once treated, LDL goal is <100–130 mg/dLNHLBI (ATP III, Integrated Guidelines*), AAP, AHA
Fasting lipid profileAdults without CVDLDL <100 mg/dLStatins, goal LDL <100 mg/dLNHLBI (ATP III), ADA
Fasting lipid profileAdults with CVDLDL <70 mg/dLStatins, goal LDL <70 mg/dLNHLBI (ATP III), ADA
HypertensionBPEvery visitAdults: >140/80 mmHg, goal <130/80 mmHg; children: BP >95th percentile or >130/80 mmHgLifestyle modifications for those with BP >120/80 mmHg: low salt, high fruits and vegetables, regular exerciseNHLBI (JNC 7), ADA
Medications for those with BP >140/80 mmHg, or 130/80 mmHg in some younger individuals: ACE or ARB inhibitor, add others as necessary to achieve normal BP
PrehypertensionBPEvery visitAdults: 120–130/80–89 mmHg; children: BP
90th–95th percentile
Borderline BP: low salt, high fruits and vegetables; regular exerciseADA
Thrombosis preventionNoneAge ≥21 yAdults with CVDAspirinNHLBI (ATP III)
  • AAP, American Academy of Pediatrics; ACE, angiotensin-converting enzyme; ADA, American Diabetes Association; AHA, American Heart Association; ARB, angiotensin receptor blocker; ATP III, Adult Treatment Panel III; BP, blood pressure; CVD, cardiovascular disease; DKD, diabetic kidney disease; GFR, glomerular filtration rate; HbA1c, hemoglobin A1c; HDL-C, high-density lipoprotein cholesterol; JNC, Joint National Committee; LDL, low-density lipoprotein; mo, month; NHLBI, National Heart, Lung, and Blood Institute; NKF, National Kidney Foundation; T1DM, type 1 diabetes mellitus; y, year.

  • * Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents (125).