Management of lipid disorders is critical in preventing vascular complications in patients with diabetes, however robust evidence based strategies for managing lipids in T1D are limited. International guidelines suggest considering statins in all patients with T1D, but particularly those with one or more of age >40, duration of diabetes > 10 years, established nephropathy or established cardiovascular risk factors. The Australian Heart Foundation general lipid targets are total cholesterol <4.0mmol/L, HDL >/= 1mmol/L, LDL < 2.0mmol/L and triglyceride < 2.0mmol/L.
To describe lipid profiles and therapy in patients with T1D seen at an adult diabetes clinic and to review our compliance with national treatment guidelines.
We conducted a retrospective audit of lipids and lipid lowering treatment in patients with TID attending clinic between May 2011- May 2016 using the BioGrid Diabetes database.
There were 553 patients (mean age 41.5 years) with T1D with lipid results recorded within the past 6 years. 454/553 (82%) had either LDL > 2.0mmol/L or HDL <1.0mmol/L. Of these only 92 (17%) were treated with statins. Of the 473 patients with duration of diabetes and ACR recorded, 426 (90%) met one or more of age > 40, duration > 10 years or ACR >4.0. Of these, 118 (28%) were on a statin. The mean LDL in those treated with a statin was 2.46 mmol/L compared with 2.76 mmol/L in those not treated (p<0.0005.)
Even amongst the higher risk patients, only a small proportion are treated with a statin and the majority of patients are not meeting heart foundation lipid targets. A review of how well lipid guidelines reflect contemporary practice, and which patient and clinician factors influence appropriate use of statins may enable a better understanding of how to improve management of lipids in this cohort.