Researchers Propose Blood Pressure,
Cholesterol Goals for Type 1 Diabetics

Researchers at the University of Pittsburgh Graduate School of Public Health have proposed the first-ever blood pressure and cholesterol goals for people with type 1 diabetes, a group that is at high risk for coronary artery disease and premature death. Research findings will be published in the June issue of Diabetes Care, a journal of the American Diabetes Association.

“For reasons that are unclear, people with type 1 diabetes have more than double the risk of cardiovascular disease than do those without diabetes, but no guidelines exist to help set goals for two of the most important risk factors for the complications for this disease — lipids and blood pressure,” said senior investigator Trevor Orchard, M.D., professor of epidemiology, medicine, and pediatrics at the University of Pittsburgh.

Orchard’s study, which was funded by the National Institutes of Health, indicates that people with type 1 diabetes should control vigorously these two risk factors, aiming for goals as strict or stricter than those currently in place for people with cardiovascular disease.

Investigators set the goals based on their analysis of data from the Pittsburgh Epidemiology of Diabetes Complications (EDC) Study, a 10-year prospective study of 589 adults with childhood-onset type 1 diabetes. Study subjects had been diabetic for an average of 20 years. Orchard and his colleagues looked at the subjects’ blood pressure, HDL (“good”) cholesterol, LDL (“bad”) cholesterol, and triglyceride levels and noted the points at which subjects died, or developed coronary artery disease or microvascular disease.

Based on these analyses, the researchers suggest the following levels for men and women ages 18-55 with type 1 diabetes: LDL cholesterol, less than 100 mg/dl; HDL cholesterol, more than 45 mg/dl; triglycerides, less than 150 mg/dl; and blood pressure, less than 120/80.

Guidelines set by the American Diabetes Association and the National Cholesterol Education Program generally apply to type 2 diabetes, according to Orchard.

“Goal-setting for patients with type 1 diabetes is more complex because of the higher occurrence of microvascular complications that we have shown to be related to blood lipids and blood pressure levels as well,” Orchard said. “Additional complications are caused by the relationship between renal disease and coronary artery disease in people with type 1.”

Also, because people with type 1 often have had diabetes and the accompanying risk factors since childhood, resulting diseases are more likely to manifest themselves over time in these patients than in people with type 2, who normally develop diabetes in adulthood.

During the 10-year period, 67 subjects died, 105 developed coronary artery disease, 92 developed lower-extremity arterial disease, 52 developed overt nephropathy, 120 developed distal symmetrical polyneuropathy, and 148 developed proliferative retinopathy. Adjustments for age and gender were generally minor.

—Kathryn Duda