THERAPY, GLYCAEMIC CONTROL AND COMPLICATIONS IN TYPE 1 DIABETIC PATIENTS : RESULTS FROM A SINGLE CENTRE COHORT OF 465 SUBJECTS

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Abstract
We analysed the clinical characteristics, the degree of glycaemic control and the prevalence of complications in 465 type 1 diabetic adult patients (232 males), in view of current recommendations for metabolic and blood pressure control. Age and diabetes duration were 45 +/- 17 and 20 +/- 13 years respectively (mean +/-1 SD). Daily insulin dose was 0.65 +/-0.24 U/kg b.w. 73% of patients received greater than or equal to3 injections/day, while 11% had continuous subcutaneous insulin infusion. All were practizing home blood glucose monitoring. Current HbA(1)c was 8.5% [7.7-9.3%] (median [percentiles 25-75]). There was no difference in HbA(1)c according to number of injections or CSII use. When patients were divided according to HbA(1)c quintiles, significantly lower prevalences of retinopathy and neuropathy were found in quintile 1 individuals. A mean of 53 severe, hypoglycaemic episodes was reported per 100 patients/year, and they were more frequent in subjects exhibiting better glycaemic control. High blood pressure levels were found in 27% of subjects according to JNC-VI criteria. Fasting cholesterol (C), LDL-C, HDL-C and triglycerides were within normal range. However, according to current guidelines emphasizing on lower target thresholds, up to 27% of patients exhibited some degree of dyslipidaemia, in particular LDL-C higher than 3.3 mmol/l. In conclusion, in this large cohort of type 1 diabetic patients regularly attending a University Centre, overall glycaemic control remains above the satisfactory levels inferred from optimization studies. Although mean blood pressure and blood lipids were up to recently deemed adequate, a (too) high proportion of diabetic patients exhibited either hypertension and/or dyslipidaemia according to revised therapeutic goals cut-offs.

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