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J Diabetes Complications. 2019 Jun 7. pii: S1056-8727(18)31283-2. doi: 10.1016/j.jdiacomp.2019.05.026. [Epub ahead of print]

Metabolic health and vascular complications in type 1 diabetes.

Author information

1
Diabetes Endocrinology and Metabolic Medicine, Faculty of Medicine, Imperial College London, UK. Electronic address: Sandhya.bhattarai@nhs.net.
2
Diabetes Endocrinology and Metabolic Medicine, Faculty of Medicine, Imperial College London, UK. Electronic address: i.godsland@imperial.ac.uk.
3
Diabetes Endocrinology and Metabolic Medicine, Faculty of Medicine, Imperial College London, UK. Electronic address: s.misra@imperial.ac.uk.
4
Diabetes Endocrinology and Metabolic Medicine, Faculty of Medicine, Imperial College London, UK. Electronic address: d.johnston@imperial.ac.uk.
5
Diabetes Endocrinology and Metabolic Medicine, Faculty of Medicine, Imperial College London, UK. Electronic address: nick.oliver@imperial.ac.uk.

Abstract

AIMS:

Optimal glycaemic control benefits risk of microvascular and macrovascular complications in type 1 diabetes (T1DM) but the importance of other components of metabolic health is less certain, particularly in the context of routine clinical practice.

METHODS:

Data for this cross-sectional analysis derived from a database covering inner North West London adult diabetes clinics. People with T1DM and with complete information for height, weight, blood pressure and serum high and low-density lipoprotein cholesterol (HDL-c and LDL-c) and triglyceride concentration measurements were included.

RESULTS:

Among the 920 participants, those with complications were older and had longer duration of diabetes but had similar HbA1c to people without complications. Systolic hypertension and low HDL-c were independently associated with complications. From having 0 risk factors, the prevalence of micro and macrovascular disease increased with increasing number of risk factors. Relative to those with ≥1 risk factor, those with 0 risk factors (n = 179) were at lower risk of retinopathy (OR 0.6 (0.4-0.9), p = 0.01) and nephropathy [OR 0.1 (0.04-0.3), p = 0.002], independent of individual characteristics.

CONCLUSIONS:

In routine clinical management of T1DM, associations between lipid and blood pressure risk factors and prevalent micro and macrovascular disease remain, implying that more intensive risk factor management may be beneficial.

KEYWORDS:

Macrovascular complication; Metabolic health; Microvascular complication; Risk factors; Type 1 diabetes

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