Cardiovascular Risks Inflict Nearly Half of All Type 1 Diabetes Patients

risk factors (CVRFs) are prevalent in nearly half of all patients with type 1 diabetes, according to a new multivariate analysis.

The resulting prevalence in the understated patient population is driving greater costs of care, and investigators’ concerns that improved cardiovascular disease management among patients with T1D.

The new study, presented at the American Diabetes Association (ADA) 2019 Scientific Sessions in San Francisco, CA, was presented by author Vijay N. Joish, PhD, of Lexicon Pharmaceuticals. In an interview with MD Magazine® while at ADA, Joish said the indicators used for CVRFs in patients with T1D included hypercholesteremia, hypertension, chronic kidney disease, or cardiovascular disease itself.

There were also serious considerations made toward patient hospitalization, costs of care, over overall mortality rates associated with risks and comorbid disease.

Joish and colleagues conducted the descriptive, multivariate study with a comparison of economic outcomes between patients with T1D, with and without cardiovascular disease or CVRFs. Their patient pool included 12,687 adults who met study criteria.

Investigators reported that 23% of patients had the prevalence of cardiovascular disease, and 42% had CVRFs. They also found patients in both groups had a significantly greater utilization of healthcare than T1D patients without cardiovascular disease nor CVRF (P< .05).

Patients with comorbid cardiovascular disease also reported greater rates of hospitalization (11% with disease; 27% with CVRF; 8% with neither) and mean number of outpatient physician visits (8.1±7.6 with cardiovascular disease; 5.0±5.1 with CVRF; 3.5±3.6 with neither).

Overall costs of all-cause care—including inpatient, outpatient, and pharmacy costs&mdash;exceeded $30,000 (mean 30,241) among T1D patients with cardiovascular disease, and $16,220 among T1D patients with CVRF&mdash;versus just $11,761 among T1D patients with neither condition.

Diabetes-related costs of care were more than doubled in T1D patients with cardiovascular disease than those with neither comorbid disease nor CVRF.

Joish called the findings—particularly the extreme rise of cardiovascular disease-comorbid T1D costs&mdash;very interesting to consider, especially in relation to the current expectations of disease burden and care surrounding type 1 versus type 2 diabetes.

“On 1 hand, type 1 diabetes patients are living longer, because of better treatment and education to better control this diabetes,” he said. “But there’s also these metabolic conditions which are well-known in type 2.”

Most importantly, T1D is an inherent, chronic condition that already requires routine monitoring and care.

“That’s always been a real challenge: getting patients to have good glycemic control, not just keeping their A1c’s low, but spending more time in range,” Joist said. “When you keep yo-yoing, that puts you at a great risk of cardiovascular disease.”

Investigators concluded that more than 1 in 5 adults with T1D suffer from cardiovascular disease, and another 2 in 5 have CVRF. These patients’ additional burdens of care and costs requirement better comorbid disease management, in order to improve patient outcomes.

“Everything happening in this space—having good CGM monitoring, for example&mdash;anything you can do to have good glycemic control and reduced weight, all of that is going to help the prevalence go down,” Joist said.

The study, “Burden of Cardiovascular Comorbidity in U.S. Adults with T1D,” was published online in ADA 2019.