ABC goal achievement predicts microvascular but not macrovascular complications over 6-years in adults with type 1 diabetes: The Coronary Artery Calcification in Type 1 Diabetes Study |
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| Institution: | 1. Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO;2. Barbara Davis Center for Diabetes, University of Colorado Denver, Aurora, CO;3. Department of Nephrology, University of Colorado Denver, Aurora, CO;1. Marmara University Training and Research Hospital, Cardiology Clinic, Istanbul, Turkey;2. Marmara University Training and Research Hospital, Internal Medicine Clinic, Istanbul, Turkey;1. Department of Cardiology, Mitsubishi Nagoya Hospital, Nagoya, Japan;2. Department of Cardiovascular Research, Research Institute of Environmental Medicine, Nagoya University, Nagoya, Japan;1. Division of Nephrology and Hypertension, University of North Carolina School of Medicine, Chapel Hill, NC;2. Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC;3. Tulane University School of Medicine, New Orleans, LA;4. Case Western Reserve University and Cleveland VA Medical Center, Cleveland, OH;5. National Eye Institute, National Institutes of Health, Bethesda, MD;6. Department of Ophthalmology, Wake Forest School of Medicine, Winston-Salem, NC;7. North Bronx Healthcare Network and Albert Einstein College of Medicine, Bronx, NY;8. Division of Endocrinology, University of North Carolina School of Medicine, Chapel Hill, NC;1. Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden;3. Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy;4. Leonardo Foundation and Diabetic Foot Unit, Policlinico Abano Terme, Abano Terme, Italy;5. Stockholm Gerontology Research Center, Stockholm, Sweden;1. Department of Ophthalmology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China 050011;2. Shijiazhuang Aier Hospital Department of Ophthalmology, Hebei Province, China 050000;3. Department of Ophthalmology, the People''s Hospital of Binzhou, Shandong Province, China 256600;4. Department of Ophthalmology, Affiliated Hospital of Chengde Medical College, Hebei Province, China 067000;1. Shanghai Key Laboratory of Diabetes Mellitus; Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes; Shanghai Jiao Tong University Affiliated Sixth People''s Hospital; Shanghai Diabetes Institute, Shanghai, China;2. Shanghai Jiao Tong University School of Medicine, Shanghai, China;3. Department of Ophthalmology, Shanghai Jiao Tong University Affiliated Sixth People''s Hospital, Shanghai, China |
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| Abstract: | HypothesisVascular complications of type 1 diabetes are thought to cluster. We examined the prevalence and incidence of vascular complications and American Diabetes Association's ABC goal achievements in a prospective cohort of adults with type 1 diabetes. We hypothesized that ABC achievement at baseline would predict both micro- and macrovascular complications over 6-years.MethodsParticipants (N = 652) were 19–56 year old at baseline and re-examined 6-years later. Microvascular complications included diabetic nephropathy (DN), defined as incident albuminuria (AER ≥ 20 μg/min) or rapid GFR decline (> 3.3%/year) by CKD-EPI cystatin C and proliferative diabetic retinopathy (PDR), defined as laser eye-therapy. Macrovascular complications were defined as coronary artery calcium progression (CACp), measured by electron-beam computed-tomography. ABC goals were defined as HbA1c < 7.0%, BP < 130/80 mmHg and LDL-C < 100 mg/dL.ResultsABC control was suboptimal with only 6% meeting all goals. Meeting no ABC goals at baseline compared to meeting all goals was associated with increased odds of developing microvascular complications (OR: 8.5, 2.3–31.5, p = 0.001), but did not reach significance for CACp (OR: 1.7, 0.8–3.9, p = 0.19).ConclusionABC achievement at baseline strongly predicted microvascular but not macrovascular complications over 6-years in adults with type 1 diabetes, suggesting a need for novel therapeutic targets to complement conventional risk factors in treating macrovascular complications. |
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