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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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