Endocrine Abstracts

Aim: Current guidelines for type 1 diabetes mellitus (DM1) suggest a therapeutic goal for glycosylated hemoglobin (A1c) of < 7.0% in adults and < 7.5% in children and adolescents, while emphasizing the importance of managing dyslipidemia. We aimed to record the achievement of therapeutic goals in DM1 patients followed-up in a Greek tertiary center.

Methods: Data were included from DM1 patients who had visited the Department at least once in the previous two years. The most recent and mean A1c value over the previous two years, body mass index (BMI), systolic and diastolic blood pressure (SAP, DAP) and lipids were recorded. Results are reported as mean (standard deviation, range).

Results: Data were included for 157 out of 616 patients; 119 adults (≥18 years) and 38 children or adolescents (< 18 years). In adults, mean age was 37 years (14, 18–70), and the most recent and mean A1c were 7.6% (1.3, 4.6–12.5) and 7.7% (1.4, 4.6–11.7) respectively. A1c < 7.0% was achieved in 34% of patients. Mean BMI was 25 kg/m² (5, 17–39), with 25% being overweight and 19% obese. Combined SAP/DAP < 140/90 mmHg was observed in 78% of patients. Total cholesterol (TC) was 188 mg/dl (43, 108–391), LDL 112 mg/dl (34, 45–200), HDL 57 mg/dl (14, 25–100) and triglycerides (TG) 99 mg/dl (137, 26–1436), whereas LDL < 100 mg/dl was observed in 42% of patients. The combined treatment goal of A1c < 7.0%, LDL < 100 mg/dl and SAP/DAP < 140/90 mmHg was achieved in 6.4% of patients. In patients < 18 years, the mean age was 13 years (3, 6–17), BMI 20 kg/m² (4, 15–35), the most recent A1c 7.4% (1.2, 5.6–11.8) and the mean A1c 7.4% (1.7, 5.4–10.3). A1c < 7.5% was achieved in 69% of patients. SAP was 110 mmHg (11, 90–129), DAP 70 mmHg (7, 60–84), TC 174 mg/dl (29, 121–259), LDL 98 mg/dl (25, 49–150), HDL 58 mg/dl (13, 39–88) and TG 84 mg/dl (60, 25–298). Insulin pump therapy was used by 26% of adults and 21% of children or adolescents. In these patients, A1c improved after pump use from 8.0% (1.8, 5.1–11.7) to 7.2% (1.1, 4.6–10.2) while the most recent A1c was 7.3% (1.1, 4.6–10.5).

Conclusions: Despite recent progress, a significant proportion of DM1 patients do not reach the therapeutic goals for glycemic, lipid and blood pressure control, whilst many are overweight or obese. Insulin pump use is associated with a sustained improvement in glycemic control.