Under-treatment of hypertension and hypercholesterolemia in children and adolescents with type 1 diabetes- Long term follow-up on time trends in the occurrence of cardiovascular disease, risk factors and medications use

Abstract

AIMS: 1) To evaluate long-term trends in the occurrence and treatment of cardiovascular disease (CVD) risk factors and occurrence of CVD events in children with type 1 diabetes mellitus (T1DM), and 2) To assess determinants of under-treatment of CVD risk factors. METHODS: A retrospective cohort study was conducted in 3,728 children (<19 years) with T1DM and up to 5 age and gender-matched diabetes-free children (reference cohort) (n=18,513) using data from the Clinical Practice Research Datalink (CPRD). RESULTS: Children with T1DM compared with diabetes-free subjects had significantly higher annual prevalence rates of CVD risk factors and cardiovascular (CV) medication use 20 years after the onset of diabetes (index date); hypertension: 35.2% vs. 11.4%, p<0.001, hypercholesterolemia: 66.7% vs. 7.14%, p<0.001 and CV medication use: 37.0% vs. 3.6%, p<0.001, respectively. The significant differences between prevalence rates in the two cohorts already started one year before the index date. Furthermore, 50% of the children in the T1DM cohort with hypertension and 53% with hypercholesterolemia remained untreated with CV drugs for a period of 2-5 years during the 20-year follow-up. Age was the only determinant associated with undertreated hypertension in the T1DM cohort. CONCLUSIONS: Children with T1DM had substantial higher prevalence rates of hypertension and hypercholesterolemia one year before up to 20 years after the onset of diabetes compared to non-diabetics. There is a substantial under-treatment of CVD risk factors with CV drugs. Screening for CVD risk factors in children with T1DM and adequate treatment is of utmost importance to prevent CVD later in life.