The consequences of failure to achieve targets of guidelines for prevention and treatment of diabetic complications in patients with type 1 diabetes

To study how the targets of glycemic, blood pressure (BP) and lipid control based on the American Diabetes Association (ADA) guidelines have been implemented, and to assess the risk of cardiovascular events (CVD) and mortality in patients with type 1 diabetes stratified by nephropathy (DN) status. A nationally representative cohort of patients with type 1 diabetes (N = 3,151) from the FinnDiane Study were included. CVD and deaths were identified from the national registers. The treatment targets were HbA_1C <7 %, BP <140/80 mmHg and LDL cholesterol <2.6 mmol/l. About 63 % of the patients with DN and 34 % of the patients without DN reached none of the targets. With DN, the 10-year cumulative risk of CVD was 17.4 % (95 % CI 11.1–23.2) if BP was on target, 29.9 % (23.0–36.2, P = 0.03) if BP was not on target and 28.4 % (24.9–31.8, P = 0.009) in those who reached none of the targets. The corresponding figures were 3.8 % (2.7–4.8), 4.4 % (2.7–6.2, P = 0.3) and 8.1 % (6.4–9.8, P < 0.0001) for those without DN. In those with DN, the risk of CVD was higher if BP was not on target [hazard ratio (HR) 1.9 (1.1–3.3)], or none of the three targets [HR 2.2 (1.4–3.6)] were reached than if BP was on target. Although the risk of death without DN was higher in those who reached none of the targets (P = 0.003), after adjustment, no differences were observed between the groups. Failure to reach ADA treatment targets is associated with increased risk of mortality and CVD in patients with type 1 diabetes.