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[IP] Lower Blood Pressure, LDL Cholesterol Goals Recommended For Type 1 Diabetics
WESTPORT, CT (Reuters Health) Jun 05 - Patients with type 1 diabetes should
have lower blood pressure, lower low-density lipoprotein (LDL) cholesterol
and higher high-density lipoprotein (HDL) cholesterol goals than those
currently recommended for patients with type 2 diabetes, according to a
report in the June issue of Diabetes Care.
"People with type 1 diabetes are at increased risk of a variety of
complications at lower blood pressures and lipid levels that are normally
considered high risk," lead author Dr. Trevor J. Orchard told Reuters
Health. "We feel that patients with type 1 diabetes should be treated more
vigorously than either type 2 diabetics or nondiabetic hypertensives."
Dr. Orchard, from the University of Pittsburgh, and colleagues collected
data on 589 adults with type 1 diabetes who participated in the Pittsburgh
Epidemiology of Diabetes Complications Study.
During 10 years of follow-up, there were 67 deaths, 105 cases of coronary
artery disease, 92 cases of lower-extremity arterial disease, 52 cases of
overt nephropathy, 120 cases of distal symmetric polyneuropathy and 148
cases of proliferative retinopathy, the researchers report. They calculated
relative risks using traditional groupings of the blood pressure and
lipid/lipoproteins values measured at baseline.
Given the results, "blood pressure in patients with type 1 diabetes should
be as low as 120/80 mm Hg, as opposed to 130/85 mm Hg, which is the current
recommendation," Dr. Orchard said. He added that patients with type 1
diabetes should have an HDL-cholesterol goal of 45 mg/dL rather than 40
mg/dL, as recommended for type 2 diabetics. LDL-cholesterol levels should be
below 100 mg/dL and triglyceride levels below 150 mg/dL.
Dr. Orchard believes that patients with type 1 diabetes have been neglected.
"Large-scale prospective studies have not been done in this group of
patients and consequently the recommendations of the national bodies focus
only on type 2 diabetes. Physicians have not vigorously identified and
treated blood pressure and lipid levels in these patients," he told Reuters
Diabetes Care 2001;24:1053-1059.
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