Diabetes Can Be Complicated

March 23, 2022

Despite the significant advancements in type 1 diabetes care over the last ten years, along with having multiple different hybrid closed-loop systems available, most Americans are not achieving glycemic goals.1 Although it’s wonderful to celebrate the trend of decreasing occurrences of complications experienced by people with type 1 diabetes, it’s also important to understand the risks that are still present.

Drs. Subramanian and Hirsch from the University of Washington published a recent article discussing the implications of the 30-year follow-up results from the landmark DCCT and EDIC trials, which provides really important insight for people with type 1 diabetes.2 The focus of their article was to review the risk for cardiovascular disease, which they define as coronary heart disease, cerebrovascular disease, and peripheral arterial disease. This includes a wide array of conditions that occur due to multiple factors, and unfortunately, having diabetes increases the risk for all of them.

One of the challenges with reducing risk for cardiovascular disease (CVD) in people with T1D is that we do not yet fully understand why people with type one diabetes tend to have build-up in their artery walls at younger ages than their peers without diabetes.2 Since this is still not understood, it can be hard to prevent the problem from occurring. There is also not much research specifically looking at reducing CVD risk in people with type 1 diabetes, and a lot of the management of risk is based on studies of people with type 2 diabetes.

There are some potentially modifiable factors that have been proven to help reduce the risk for cardiovascular disease, and those are:2

  1. Maintaining an HbA1c of <7% (every 1% above 7 increases the risk for cardiovascular disease by 31%)
  2. Not Smoking Cigarettes
  3. Maintaining Blood Pressure in Target < 130/80
  4. Keeping Cholesterol in Target: LDL <130, Triglycerides <150, HDL >40 for men, <50 for women
  5. Sustain healthy weight: BMI <25% (which notably, intensive insulin therapy makes more challenging)

There are other contributors to increased risks for CVD that cannot be modified, such as age, length of diagnosis of diabetes, gender, social determinants of health, and genetic risks. Sometimes even when you do everything you can, complications still happen, which can feel so frustrating. Diabetes Advocate, Chris Aldred, also known as The Grumpy Pumper, has been instrumental in the diabetes community for discussing complications openly and promoting the hashtag #TalkAboutComplications.

More studies are currently in progress to look at whether or not the newer medication classes of GLP-1 and SGLT-2 reduce the risk for CVD and other complications for people with type 1 diabetes. Until then, getting screened regularly for lipids, blood pressure, BMI, and HbA1c is the best way to understand what your risks are for cardiovascular disease.

  1. State of Type 1 Diabetes Management and Outcomes from the T1D Exchange in 2016–2018
  2. Intensive Diabetes Treatment and Cardiovascular Outcomes in Type 1 Diabetes Mellitus: Implications of the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study 30-Year Follow-Up

Written and clinically reviewed by Marissa Town, RN, BSN, CDCES