Patients with type 1 diabetes mellitus and recommended low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol and apolipoprotein B targets – a SwissDiab study

Background: Cardiovascular risk in type 1 diabetes mellitus (T1DM) is frequently underestimated in daily clinical practice. The aim was therefore to evaluate lipid management in patients with T1DM according to current guidelines, and agreement in target attainment across three recommended lipid biomarkers. Methods: Target attainment of (low-density lipoprotein cholesterol [LDL-C, estimated with the Friedewald formula], non-high-density lipoprotein cholesterol [non-HDL-C], and apolipoprotein B [apoB]) was determined based on the 2021 European Society of Cardiology Dyslipidemia guideline among adult patients with T1DM enrolled in SwissDiab. Results: Median age of the 216 patients included was 43.6 years, diabetes duration 16 years, HbA1c 7.3% (56 mmol/mol), 39.4% were females, 75.0% were at high, and 11.6% at very high cardiovascular risk. Prescription of lipid-lowering therapy (LLT) was low (33.6%). LDL-C target attainment was poor (11.6%), while significantly more patients reached non-HDL-C (30.6%) and apoB (59.7%) targets (P-values <0.00001). Overall, 11.1% of the patients reached all three, and 39.8% none of the lipid targets. Conclusion: Raised awareness of the importance of lipid management in T1DM is needed. However, the observed discordance in target attainment across lipid biomarkers can lead to uncertainties in clinical decision-making on how to best apply current lipid management recommendations for optimal cardiovascular risk prevention in T1DM.