Objective
The purpose of the project is to investigate the effect of multifactorial intervention in people with type 1 diabetes at high risk of developing cardiovascular disease. Our hypothesis is that such treatment will reduce the risk of blood clots in the heart or brain, death due to cardiovascular disease, hospitalization with heart failure, kidney failure and death.
Background Rationale
People with type 1 diabetes are at high risk of cardiovascular disease. Even with optimal treatment of blood sugar, the risk is doubled compared to healthy individuals. Unlike type 1 diabetes, the treatment of type 2 diabetes is based more on multifactorial intervention. By multifactorial intervention is meant the treatment of several risk factors at once, so that in addition to optimizing blood sugar, blood pressure and cholesterol levels, medication is also included that specifically protects the heart and kidneys and helps against obesity. The development of new types of medication for type 2 diabetes has had a major impact on treatment guidelines, as these types of treatments have been shown to reduce the risk of death and disease. Multifactorial intervention involves the need for treatments aimed at several risk factors for cardiovascular disease and does not focus only on blood sugar. A change in the treatment of risk factors, focusing on multifactorial intervention to lower the risk of cardiovascular disease in people with type 1 diabetes and concomitant cardiovascular disease, kidney disease, heart failure or obesity, has the potential to improve morbidity and survival in type 1 diabetes.
Description of Project
People with type 1 diabetes are at high risk of cardiovascular disease. Even with optimal treatment of blood sugar, the risk is doubled compared to healthy individuals. Unlike type 1 diabetes, the treatment of type 2 diabetes is based more on multifactorial intervention. By multifactorial intervention is meant the treatment of several risk factors at once, so that in addition to optimizing blood sugar, blood pressure and cholesterol levels, medication is also included that specifically protects the heart and kidneys and helps against obesity. The development of new types of medication for type 2 diabetes has had a major impact on treatment guidelines, as these types of treatments have been shown to reduce the risk of death and disease. Multifactorial intervention involves the need for treatments aimed at several risk factors for cardiovascular disease and does not focus only on blood sugar. A change in the treatment of risk factors, focusing on multifactorial intervention to lower the risk of cardiovascular disease in people with type 1 diabetes and concomitant cardiovascular disease, kidney disease, heart failure or obesity, has the potential to improve morbidity and survival in type 1 diabetes.
People with type 1 diabetes who are more than 40 years old and have had diabetes for more than 10 years and at the same time are at high risk of developing cardiovascular disease can participate.
The study is planned to last for 5 years. The project-related visits and examinations will take place during regular visits at the outpatient clinic the participant usually attend.Since the purpose of the project is to investigate whether a new way of treating type 1 diabetes is better than the current one, all participants will be divided equally into two groups. One group will have to continue with their usual medical treatment and will be what is called the "control group". The second group will be started on new medication in addition to the usual insulin treatment and the targets for blood pressure and cholesterol levels will be intensified. This will be the "active group".
Anticipated Outcome
The primary outcome is to determine whether multifactorial treatment is better that standard care to reduce the risk of blood clots in the heart or brain, death due to cardiovascular disease, hospitalization with heart failure, kidney failure and death.
Relevance to T1D
People with type 1 diabetes are at high risk of cardiovascular disease. Even with optimal treatment of blood sugar, the risk is doubled compared to healthy individuals. Unlike type 1 diabetes, the treatment of type 2 diabetes is based more on multifactorial intervention, interventions that are not approved for type 1 diabetes although anticipated to hvae the same positive effects in type 1 diabetes as in type 2 diabetes.