Is our treatment in type 1 diabetes mellitus (insulin therapy models, metabolic control) optimal for preventing cardiovascular autonomic neuropathy?

INTRODUCTION: Long-term poor metabolic control promotes the occurrence of microvascular complications, such cardiovascular autonomic neuropathy and atherogenic hyperlipidaemia, which translates into increased mortality in patients with type 1 diabetes (T1DM).

AIMS: To assess the prevalence of cardiovascular autonomic neuropathy (CAN) in patients with T1DM in relation to treatment method (continuous subcutaneous insulin infusion (CSII) versus multiple daily injections using pens (MDI)) and lipid control.

MATERIAL AND METHODS: The study group comprised 93 adults (60 women, 33 men), median age 31, with T1DM being treated in a local clinical centre in 2011-2015. The presence of CAN and the results of laboratory tests and anthropometric data were analysed. The subjects were divided into two groups according to treatment method (CSII, MDI).

RESULTS: The median duration of diabetes was 16 years. 61% of the subjects used MDI, 39% used CSII. 41% of the subjects presented with CAN (confirmed with Ewing's tests using ProSciCard apparatus), with a significantly lower prevalence in the group of patients treated with CSII (15.4% vs 60.4%; p <0.001). The mean HbA1c level in the CSII-treated group was noticeably lower (7.44±1.67% vs 8.55±1.1%, p<0.001) and these patients also had decreased triglyceride levels (0.71 vs 1.32mmol/l, p<0.001). Regardless of the treatment model, 72% of all the patients under 40 years of age achieved their therapeutic goal of LDL cholesterol level <2.6mmol/l whereas only 13% of all those over 40 years old achieved LDL <1.8mmol/l.

CONCLUSIONS: Optimization of metabolic control, especially the level of glycaemia, shows positive correlation with decreased frequency of the development of CAN. The results presented in this study draw attention to the high prevalence of CAN among T1DM patients. In addition, the study reveals the need for more intensive monitoring and treatment of hyperlipidaemia, despite good glycaemic control, especially in those over the age of 40 .