Achievement of cardiovascular risk factor targets in young adults with diabetes mellitus

Peter J Donovan, H David McIntyre
Department of Endocrinology, Mater Health Services, Mater Clinical School, The University of Queensland School of Medicine, South Brisbane, QLD, Australia

Background: Many patients with diabetes mellitus fail to achieve treatment targets recommended in recognized guidelines. Little data is available in this area relating to young adults.
Objective: To assess whether treatment goals for glycosylated hemoglobin (HbA_1c), blood pressure, lipid-lowering, and process outcomes for microvascular screening are being achieved in young adults with diabetes mellitus.
Methods: A retrospective clinical record audit of 202 consecutive patients with type 1 and type 2 diabetes, aged predominantly 18–45 years, attending a specialist diabetes center in Brisbane, Australia, was conducted. Assessment was made as to whether goals for HbA_1c, blood pressure, lipid lowering, and microvascular screening were being achieved. Descriptive statistics and comparison of continuous variables were produced.
Results: Mean (SD) HbA_1c was 8.30% (±1.5) with no statistical difference between patients with type 1 and type 2 diabetes (P = 0.44). Sixteen percent of patients (12% type 1, 31% type 2) had an HbA_1c of <7%. Eighty-three percent of patients had blood pressure ≤130/80 mmHg. Sixteen percent of patients with type 1 and 37% with type 2 diabetes were achieving combined lipid targets. Only 34% and 9% of patients who had an indication (and no documented contraindication) for lipid-lowering and antiplatelet therapy, respectively, were prescribed such agents. There was a significant difference in achievement of macrovascular treatment targets in patients with type 1 and type 2 diabetes, but no difference in screening or treatment outcomes in microvascular disease. Patients below the age of 25 years were less likely to achieve macrovascular treatment targets.
Conclusion: A large number of young adult patients with diabetes mellitus do not achieve recognized treatment targets. There appears to be less emphasis placed on macrovascular risk factor targets compared with previous audits in older patients, in patients with type 1 diabetes compared with type 2 diabetes and in patients younger than 25 years.

Keywords: diabetes mellitus, complications, vascular risk, hypertension, cholesterol, glycated hemoglobin