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[IP] Lipid and Blood Pressure Treatment Goals for Type 1 Diabetes



Item #14
Lipid and Blood Pressure Treatment Goals for Type 1 Diabetes
      www.diabetesincontrol.com/issue54/item14F.htm

OBJECTIVESubjects with type 1 diabetes are at high risk for many long-term
complications, including early mortality and coronary artery disease (CAD). 
Few
data are available on which to base goal levels for two major risk factors,
namely blood pressure and lipid/lipoproteins. The objective of this study 
was to
determine at which levels of LDL and HDL cholesterol, triglycerides, and 
blood
pressure the relative risks of type 1 diabetic complications increase
significantly.

RESEARCH DESIGN AND METHODSObservational prospective study of 589 patients 
with
childhood-onset type 1 diabetes (<17 years) aged  18 years at baseline; 
10-year
incidence of mortality, CAD, lower-extremity arterial disease, proliferative
retinopathy, distal symmetric polyneuropathy, and overt nephropathy. 
Relative
risks were determined using traditional groupings of blood pressure and
lipid/lipoproteins, measured at baseline, using the lowest groupings (<100 
mg/dl
[2.6 mmol/l] LDL cholesterol, <45 mg/dl [1.1 mmol/l] HDL cholesterol, <100 
mg/dl
[1.1 mmol/l] triglycerides, <110 mmHg systolic blood pressure, and <80 mmHg
diastolic blood pressure) as reference. Adjustments for age, sex, and 
glycemic
control were examined.

RESULTSDriven mainly by strong relationships with mortality, CAD, and overt
nephropathy, suggested goal levels are as follows: LDL cholesterol <100 
mg/dl
(2.6 mmol/l), HDL cholesterol >45 mg/dl (1.1 mmol/l), triglycerides <150 
mg/dl
(1.7 mmol/l), systolic blood pressure <120 mmHg, and diastolic blood 
pressure
<80 mmHg. Age, sex, and glycemic control had little influence on these 
goals.

CONCLUSIONSAlthough observational in nature, these data strongly support 
the
case for vigorous control of lipid levels and blood pressure in patients 
with
type 1



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