Trends in cardiovascular risk factor management in type 1 diabetes by sex: the Pittsburgh EDC study

Background: The Diabetes Control and Complications Trial demonstrated a reduced incidence of microvascular and macrovascular disease with intensive diabetes management among those with type 1 diabetes (T1D). However, to what extent the general T1D population practices intensive management has not been well studied. Our aim was therefore to assess trends in cardiovascular disease risk factors among men and women with T1D. We further evaluated the proportion adhering to the American Diabetes Association’s (ADA) guidelines and recommendations for the prevention of acute and long-term complications of diabetes. Methods: We based our investigation on the Pittsburgh Epidemiology of Diabetes Complications (EDC) study of individuals with childhood-onset T1D (n=658; 325 women, 333 men). At baseline, the mean age was 28 years and the mean diabetes duration was 19 years. Following a clinical exam at study entry, participants have been followed biennially for up to 20 years. We assessed the proportion of EDC participants at each clinical examination adhering to the ADA Recommendations. Participant adherence to intensive insulin therapy and statin use was also assessed. Results: During 20 years of follow-up, adherence to ADA recommendations increased for HbA1c (from 9.6 to 35.2%,