Introduction
Absolute cardiovascular risk assessment is challenging for people with T1DM, especially those under 45 years of age. People with T1DM have significantly elevated life-time risk of cardiovascular disease but young age and statistical uncertainty in prediction models leads to ambiguity in setting treatment thresholds. This study considers the distribution of cardiovascular risk factors in younger and older patients with T1DM attending diabetes centres.
Methods
Data from the Australian National Diabetes Audit (ANDA) from 49 diabetes centres across Australia were analysed. Subjects comprised all patients with T1DM presenting to a participating Diabetes Centre during the 1-month survey period in May or June 2015. Pre-specified demographic and clinical variables were obtained. Means and standard deviations were calculated for continuous variables and frequencies (%) for categorical variables. Differences were assessed using independent t-tests and chi square tests as appropriate.
Results
Among the 1,248 subjects, patients <45 years compared to >45 years had a significantly higher mean (±SD) HbA1c (8.6±1.9% vs 8.4±1.6%, p= 0.044), total cholesterol level (4.8 ± 1.1mmol/L vs 4.6 ± 1.1mmol/L, p <0.001) and low density lipoprotein cholesterol level (2.7 ± 0.9mmo/L vs 2.3 ± 0.9mmol/L, p <0.001). In contrast, systolic blood pressure (119.1 ± 15.1 mmHg vs 131.9 ± 17.9 mmHg) and BMI (26.1 ± 6.2 vs 27.7 ± 6.6 kgm2) were lower and smoking less prevalent (30.3% vs 48.1%) among the younger compared to older patients (Table 1).
Conclusion
Younger patients with T1DM have poorer glycaemic control and lipids levels than older patients. A large proportion of both younger and older patients continue to smoke. Given the increased life-time cardiovascular risk of patients with T1DM, strategies to optimise management of these risk factors are urgently required.