Metabolic health in people living with type 1 diabetes in Belgium: a repeated cross-sectional study

IF 8.4 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Diabetologia Pub Date : 2024-09-13 DOI:10.1007/s00125-024-06273-7
Astrid Lavens, Christophe De Block, Philippe Oriot, Laurent Crenier, Jean-Christophe Philips, Michel Vandenbroucke, An-Sofie Vanherwegen, Frank Nobels, Chantal Mathieu
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The Initiative for Quality Improvement and Epidemiology in Diabetes, imposed by the Belgian health insurance system, has systematically collected data from patients on intensive insulin therapy treated in all 101 diabetes clinics in Belgium since 2001. The aim of this real-world study is to describe the evolution of treatment and metabolic health, including the prevalence of obesity and combined metabolic abnormalities, in people living with type 1 diabetes over the past 20 years, and to compare the treatment and prevalence of complications between those with and without combined metabolic abnormalities.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>We analysed data on adults (≥16 years old) living with type 1 diabetes, who were diagnosed at age ≤45 years and who had a diabetes duration ≥1 year, collected between 2001 and 2022. The evolution of HbA<sub>1c</sub>, BMI, LDL-cholesterol, systolic BP, lipid-lowering therapy and antihypertensive therapy over time was analysed. The prevalence of individual and multiple metabolic abnormalities according to various definitions of the metabolic syndrome/combined metabolic abnormalities was analysed, and the association between combined metabolic abnormalities and metabolic health indicators, complications and treatment was investigated in the 2022 data.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The final dataset consisted of 26,791 registrations of adults living with type 1 diabetes collected between 2001 and 2022. Although glycaemic and lipid control generally improved over time, the prevalence of obesity strongly increased (12.1% in 2001 vs 21.7% in 2022, <i>p</i>&lt;0.0001), as did the presence of combined metabolic abnormalities (WHO criteria: 26.9% in 2001 vs 42.9% in 2022 in women, <i>p</i>&lt;0.0001; 30.4% in 2001 vs 52.1% in 2022 in men, <i>p</i>&lt;0.0001; WHO criteria without albuminuria: 22.3% in 2001 vs 40.6% in 2022 in women, <i>p</i>&lt;0.0001; 25.1% in 2001 vs 49.2% in 2022 in men, <i>p</i>&lt;0.0001; NCEP-ATPIII criteria: 39.9% in 2005 vs 57.2% in 2022 in women, <i>p</i>&lt;0.0001; 40.8% in 2005 vs 60.9% in 2022 in men, <i>p</i>&lt;0.0001; IDF criteria: 43.9% in 2005 vs 59.3% in 2022 in women, <i>p</i>&lt;0.001; 33.7% in 2005 vs 50.0% in 2022 in men, <i>p</i>&lt;0.0001). People with combined metabolic abnormalities had higher glucose levels compared to those without combined metabolic abnormalities (HbA<sub>1c</sub> &gt;58 mmol in men: 48.9% vs 36.9%; HbA<sub>1c</sub> &gt;58 mmol in women: 53.3% vs 41.1%, <i>p</i>&lt;0.0001). People with combined metabolic abnormalities were more often treated with adjunct therapies such as metformin, sodium–glucose transport protein 2 inhibitors and glucagon-like peptide-1 receptor agonists. In both men and women, the presence of combined metabolic abnormalities was strongly related to the presence of eye complications, peripheral neuropathy, chronic kidney disease and CVD, corrected for age, diabetes duration and HbA<sub>1c</sub>.</p><h3 data-test=\"abstract-sub-heading\">Conclusions/interpretation</h3><p>Overweight, obesity and combined metabolic abnormalities are increasingly being identified in people living with type 1 diabetes, further accelerating the risk of microvascular and macrovascular complications. Early identification of the presence of combined metabolic abnormalities should enable therapeutic interventions to be modified towards multifactorial approaches, with attention to education on avoidance of overweight (e.g. dietary counselling) in addition to strict glycaemic control and intensification of use of antihypertensive agents and statins. 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Abstract

Aims/hypothesis

Metabolic abnormalities such as central obesity, insulin resistance, dyslipidaemia and hypertension, often referred to as ‘the metabolic syndrome’ (or ‘combined metabolic abnormalities’), are increasingly being identified in people living with type 1 diabetes, accelerating the risk for CVD. As a result, in recent years, treatment in people living with type 1 diabetes has shifted to improving overall metabolic health rather than glucose control alone. In Belgium, diabetes care for people living with type 1 diabetes is centrally organised. The Initiative for Quality Improvement and Epidemiology in Diabetes, imposed by the Belgian health insurance system, has systematically collected data from patients on intensive insulin therapy treated in all 101 diabetes clinics in Belgium since 2001. The aim of this real-world study is to describe the evolution of treatment and metabolic health, including the prevalence of obesity and combined metabolic abnormalities, in people living with type 1 diabetes over the past 20 years, and to compare the treatment and prevalence of complications between those with and without combined metabolic abnormalities.

Methods

We analysed data on adults (≥16 years old) living with type 1 diabetes, who were diagnosed at age ≤45 years and who had a diabetes duration ≥1 year, collected between 2001 and 2022. The evolution of HbA1c, BMI, LDL-cholesterol, systolic BP, lipid-lowering therapy and antihypertensive therapy over time was analysed. The prevalence of individual and multiple metabolic abnormalities according to various definitions of the metabolic syndrome/combined metabolic abnormalities was analysed, and the association between combined metabolic abnormalities and metabolic health indicators, complications and treatment was investigated in the 2022 data.

Results

The final dataset consisted of 26,791 registrations of adults living with type 1 diabetes collected between 2001 and 2022. Although glycaemic and lipid control generally improved over time, the prevalence of obesity strongly increased (12.1% in 2001 vs 21.7% in 2022, p<0.0001), as did the presence of combined metabolic abnormalities (WHO criteria: 26.9% in 2001 vs 42.9% in 2022 in women, p<0.0001; 30.4% in 2001 vs 52.1% in 2022 in men, p<0.0001; WHO criteria without albuminuria: 22.3% in 2001 vs 40.6% in 2022 in women, p<0.0001; 25.1% in 2001 vs 49.2% in 2022 in men, p<0.0001; NCEP-ATPIII criteria: 39.9% in 2005 vs 57.2% in 2022 in women, p<0.0001; 40.8% in 2005 vs 60.9% in 2022 in men, p<0.0001; IDF criteria: 43.9% in 2005 vs 59.3% in 2022 in women, p<0.001; 33.7% in 2005 vs 50.0% in 2022 in men, p<0.0001). People with combined metabolic abnormalities had higher glucose levels compared to those without combined metabolic abnormalities (HbA1c >58 mmol in men: 48.9% vs 36.9%; HbA1c >58 mmol in women: 53.3% vs 41.1%, p<0.0001). People with combined metabolic abnormalities were more often treated with adjunct therapies such as metformin, sodium–glucose transport protein 2 inhibitors and glucagon-like peptide-1 receptor agonists. In both men and women, the presence of combined metabolic abnormalities was strongly related to the presence of eye complications, peripheral neuropathy, chronic kidney disease and CVD, corrected for age, diabetes duration and HbA1c.

Conclusions/interpretation

Overweight, obesity and combined metabolic abnormalities are increasingly being identified in people living with type 1 diabetes, further accelerating the risk of microvascular and macrovascular complications. Early identification of the presence of combined metabolic abnormalities should enable therapeutic interventions to be modified towards multifactorial approaches, with attention to education on avoidance of overweight (e.g. dietary counselling) in addition to strict glycaemic control and intensification of use of antihypertensive agents and statins. Use of adjunct therapies in this population as a tool should be explored more thoroughly to reduce risk of complications.

Graphical Abstract

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比利时 1 型糖尿病患者的代谢健康:重复横断面研究
目的/假设1 型糖尿病患者中越来越多地出现代谢异常,如中心性肥胖、胰岛素抵抗、血脂异常和高血压,通常被称为 "代谢综合征"(或 "合并代谢异常"),从而增加了心血管疾病的风险。因此,近年来对 1 型糖尿病患者的治疗已转向改善整体代谢健康,而不仅仅是控制血糖。在比利时,1 型糖尿病患者的糖尿病治疗是集中组织的。自2001年以来,比利时医疗保险系统实施的糖尿病质量改进和流行病学计划系统地收集了比利时所有101家糖尿病诊所中接受胰岛素强化治疗的患者的数据。这项真实世界的研究旨在描述过去20年中1型糖尿病患者的治疗和代谢健康状况的变化,包括肥胖和合并代谢异常的患病率,并比较有合并代谢异常和没有合并代谢异常的患者的治疗情况和并发症的患病率。方法我们分析了2001年至2022年期间收集的1型糖尿病成年患者(≥16岁)的数据,这些患者确诊时年龄≤45岁,糖尿病病程≥1年。分析了 HbA1c、BMI、低密度脂蛋白胆固醇、收缩压、降脂治疗和降压治疗随时间的变化情况。根据代谢综合征/合并代谢异常的不同定义,分析了单个和多个代谢异常的患病率,并在 2022 年的数据中调查了合并代谢异常与代谢健康指标、并发症和治疗之间的关联。虽然随着时间的推移,血糖和血脂控制情况普遍有所改善,但肥胖症的发病率却大幅上升(2001 年为 12.1%,2022 年为 21.7%,p<0.0001),合并代谢异常的比例也有所上升(根据世界卫生组织的标准,2001 年为 26.9%,2022 年为 42%):WHO标准:女性2001年为26.9%,2022年为42.9%,p<0.0001;男性2001年为30.4%,2022年为52.1%,p<0.0001;WHO标准(无白蛋白尿):女性2001年为22.3%,2022年为40.6%,p<0.0001;男性2001年为25.1%,2022年为49.2%,p<0.0001;NCEP-ATPIII标准:2005年女性为39.9%,2022年为57.2%,p<0.0001;2005年男性为40.8%,2022年为60.9%,p<0.0001;IDF标准:2005年女性为43.9%,2022年为59.3%,p<0.001;2005年男性为33.7%,2022年为50.0%,p<0.0001)。与没有合并代谢异常的人相比,合并代谢异常的人血糖水平更高(男性 HbA1c >58 mmol:48.9% vs 36.9%;女性 HbA1c >58 mmol:53.3% vs 41.1%,p<0.0001)。合并代谢异常的患者更常接受二甲双胍、钠-葡萄糖转运蛋白 2 抑制剂和胰高血糖素样肽-1 受体激动剂等辅助疗法。在男性和女性中,合并代谢异常与眼部并发症、周围神经病变、慢性肾病和心血管疾病的发生密切相关,并对年龄、糖尿病病程和 HbA1c 进行了校正。结论/解释超重、肥胖和合并代谢异常在 1 型糖尿病患者中的发现越来越多,这进一步增加了微血管和大血管并发症的风险。及早发现合并代谢异常应能使治疗干预措施向多因素方法转变,除了严格控制血糖和加强使用降压药和他汀类药物外,还应注意避免超重的教育(如饮食咨询)。应更深入地探讨在这一人群中使用辅助疗法作为降低并发症风险的工具。
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来源期刊
Diabetologia
Diabetologia 医学-内分泌学与代谢
CiteScore
18.10
自引率
2.40%
发文量
193
审稿时长
1 months
期刊介绍: Diabetologia, the authoritative journal dedicated to diabetes research, holds high visibility through society membership, libraries, and social media. As the official journal of the European Association for the Study of Diabetes, it is ranked in the top quartile of the 2019 JCR Impact Factors in the Endocrinology & Metabolism category. The journal boasts dedicated and expert editorial teams committed to supporting authors throughout the peer review process.
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