Improvement of Care & Outcome


Rita Varkevisser, Erwin Birnie, Charlotte Vollenbrock, Dick Mul, Peter van Dijk, Melanie van der Klauw, Henk Veeze, Bruce Wolffenbuttel, Henk-Jan Aanstoot.

Cardiovascular risk management in people with type 1 diabetes: performance using three guidelines. BMJ Open Diabetes Res Care. 2022 Jul;10(4):e002765

Cardiovascular disease (CVD) is the main co-morbidity and cause of mortality in T1D. Although treatments to combat CVD, mainly lipid-lowering and anti-hypertensive medication (LLM and AHM, respectively), have much improved, an excess of CVD morbidity and mortality in T1D still exists. Different cardiovascular risk management (CVRM) guidelines offer different recommendations for the T1D population, the effectiveness of which has so far not been assessed in prospective studies. This study, co-authored by Erwin Birnie, Dick Mul, Henk Veeze and Henk-Jan Aanstoot of Diabeter, aimed to compare lipid and blood pressure management with the prescribed medication according to the Dutch (2018), ADA (2018) and NICE (2014) guidelines.


In this cross-sectional record review study, data were collected from 1,855 people with T1D (PWDs) visiting Diabeter and the University Medical Center Groningen (UMCG). Demographic, anthropomorphic, laboratory and medication data and data on diabetes-related complications was extracted from electronic medical records for the period 1-1-2018 to 31-12-2018.

Key findings:

  • LLM and AHM were prescribed in 19% and 17% of PWDs, respectively
  • There seems to be undertreatment:
    • Only 22% to 46% of PWDs recommended LLM were actually prescribed them
    • 52% to 75% of PWDs recommended AHM were prescribed them
  • For all guidelines, number of recommended and actual prescriptions increased with age
  • In the younger groups discrepancies between recommendations and actual prescriptions were more pronounced
  • Less than half of PWDs reached target values of HDL-cholesterol while on LLM and blood pressure while on AHM


Concluding, the authors state

"In conclusion, this study shows that there is potential undertreatment of lipid and blood pressure management in individuals with type 1 diabetes, as seen in the gap between guideline recommendations and medication prescription. Moreover, treatment targets are not met by most individuals using LLM and AHM. Younger appear to be particularly vulnerable to undertreatment ………… higher-quality evidence specific to individuals with type 1 diabetes may be beneficial for robust evidence-based CVRM recommendations. " -

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