Prevalence and management of modifiable cardiovascular risk factors among adolescents and young adults with type 1 diabetes – a cross-sectional analysis from the Diabetes Prospective Follow-Up Registry DPV

Alena Welters; Schwab Karl Otfried; Christina Reinauer; Claudia Boettcher; Melanie Hess; Heike Bartelt; Axel Dost; Angela Galler; Holl Reinhard W

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ESPE Abstracts (2024) 98 RFC15.5

ESPE2024 Rapid Free Communications Late Breaking (6 abstracts)

Prevalence and management of modifiable cardiovascular risk factors among adolescents and young adults with type 1 diabetes – a cross-sectional analysis from the Diabetes Prospective Follow-Up Registry DPV

Alena Welters ¹ , Karl Otfried Schwab ² , Christina Reinauer ¹ , Claudia Boettcher ³ , Melanie Hess ⁴ , Heike Bartelt ⁵ , Axel Dost ⁶ , Angela Galler ⁷ & Reinhard W Holl ⁸

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¹Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Duesseldorf, Germany. ²Medizinisches Versorgungszentrum (MVZ) Clotten, Freiburg, Germany. ³Paediatric Endocrinology and Diabetology, University Children's Hospital, Julie-von-Jenner Haus, University of Bern, Bern, Switzerland. ⁴Department of Pediatric Endocrinology and Diabetology, University Children's Hospital Basel, Basel, Switzerland. ⁵Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany. ⁶Department of Paediatrics and Adolescent Medicine, University Hospital Jena, Jena, Germany. ⁷Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Sozialpädiatrisches Zentrum, Paediatric Endocrinology and Diabetology, Berlin, Germany. ⁸Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany

Background: Cardiovascular disease (CVD) and premature death are major consequences for individuals with type 1 diabetes (T1DM). While diabetes mellitus is an independent risk factor for the development of CVD, excess risk is highly dependent on the presence or absence of additional CV risk factors such as obesity, dyslipidemia, arterial hypertension and smoking. The combination, or clustering of several risk factors exponentially increases CVD risk. Targeting modifiable CV risk factors in individuals with diabetes is essential to reduce CV long-term complications. However, previous studies have indicated insufficient awareness and treatment of CV risk factors in individuals with T1DM.

Objective and hypotheses: To assess the spectrum, prevalence and management of cardiovascular risk factors among 29.068 adolescents and young adults with type 1 diabetes, registered in the Diabetes Prospective Follow-up registry DPV, and to identify predictors for multiple CV risk factors and predictors for the onset of microvascular complications.

Method: The prevalence of five cardiovascular risk factors, i.e. obesity (BMI > 30 kg/m²), hypertension (RR > 130/80 mmHg), dyslipidemia (LDL > 130 mg/dl), poor glycemic control (HbA1c > 9%), and smoking were analyzed in 9178 adolescents and young adults (17-26 years) with T1DM with complete documentation of all five risk domains. Logistic regression models were used to identify predictors for increased cardiometabolic risk and onset of microvascular complications.

Results: At least one CV risk factor was found in almost half of all individuals (48.9%). Two CV risk factors were found in 13.6%, and three or more risk factors in 4.7%. Poor glycemic control (21.8%) and hypertension (18.6%) were the most frequent, followed by dyslipidemia (14.1%), smoking (10.5%) and obesity (7.4%). Male individuals were more often affected by hypertension and were more often smoking, while overweight/obesity and dyslipidemia were more common in females (all P <0.01). Diabetes duration and migrational background, but not sex or pubertal onset of diabetes, were associated with the overall number of CV risk factors. The number of CV risk factors present predicted the development of retinopathy and microalbuminuria. Among individuals with dyslipidemia (LDL >130 mg/dl) and hypertension (RR above treatment cut-off > 140/90 mmHg) only 10% and 18% were treated with lipid-lowering or antihypertensive medication, respectively. 4.4% of overweight/obese individuals (BMI >25 kg/m²) with T1DM received metformin.

Conclusion: Modifiable cardiovascular risk factors are common in adolescents and young adults with type 1 diabetes, associated with the onset of microvascular complications. Hypertension and dyslipidemia are currently underrecognized and insufficiently treated.