Improvement of Care & Outcome


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

Type 1 diabetes management: Room for improvement. J Diabetes. 2023 Mar;15(3):255-263.

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. To improve care for and self-management by people with T1D (PWDs), it is necessary to assess if they are reaching blood pressure and low-density lipoprotein-cholesterol (LDL-c) target values. Percentages of PWDs reaching target values vary widely in the literature. This study, co-authored by Erwin Birnie, Dick Mul and Henk-Jan Aanstoot of Diabeter, aimed to assess the percentage of PWDs achieving target values of HbA1c, LDL-c and blood pressure.


In this cross-sectional record review study, data were collected from 1,737 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:

  • Mean HbA1c was 63 mmol/ mol (7.9%), LDL-c was 2.67 mmoL/L, and BP 131/76 mm Hg.
  • HbA1c, LDL-c and BP targets were achieved by respectively:
    • 24%, 33%, and 46% of individuals with CVD
    • 29%, 54%, and 77% of individuals without CVD
  • For people with CVD no significant risk factors for HbA1c, LDL-c, and BP target achievement were found, likely due to relatively low numbers (n=87 with CVD vs n=1,650 without CVD).
  • For people without CVD:
    • Gender (being male) and mode of insulin administration (insulin pump users) associated with achieving glycemic targets
    • Smoking, microvascular complications, and the prescription of lipid-lowering and antihypertensive medication associated with not achieving glycemic targets
    • No characteristics were associated with LDL-c target achievement
    • Microvascular complications and antihypertensive medication prescription associated with not achieving BP targets


Concluding, the authors state

"In conclusion, this study emphasizes that individuals with T1D with established CVD are at a greater risk for not achieving lipid and blood pressure targets. Opportunities for the improvement of glycemic, lipid, and blood pressure management exist but may differ between individuals with and without CVD " -

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