Objective
The objective of this study is to generate a comprehensive understanding of how cardiovascular disease (CVD) prevention therapies are used in people with type 1 diabetes (T1D), and to identify the key factors that influence their use.
Specifically, the study aims to:
1. Characterize real-world treatment patterns
Quantify the use of lipid-lowering therapies, antihypertensives, and antiplatelet agents among people with T1D, including variation across patient subgroups such as age, risk profile, and prevention status.
2. Identify provider drivers and barriers
Understand how healthcare providers make decisions about prescribing CVD prevention therapies in T1D, including how guidelines are interpreted and what factors may limit prescribing in clinical practice.
3. Understand patient perspectives and barriers
Explore patient awareness of cardiovascular risk, attitudes toward preventive therapies, and factors that influence acceptance, adherence, or discontinuation of treatment.
4. Identify opportunities to improve uptake
Translate findings into actionable strategies that can be implemented by Breakthrough T1D and other stakeholders to improve use of guideline-recommended therapies.
5. Disseminate findings
Share results through peer-reviewed publications to increase awareness of gaps in CVD prevention in T1D and support evidence-based improvements in care
Background Rationale
Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in people with type 1 diabetes (T1D). Individuals with T1D face a substantially elevated risk of cardiovascular events compared to the general population, and these events often occur at a younger age. Despite this high burden, prevention strategies are not consistently applied in clinical practice.
Clinical guidelines recommend the use of lipid-lowering therapies, antihypertensives, and antiplatelet agents to reduce CVD risk in people with diabetes, including T1D. However, these recommendations are largely based on evidence from type 2 diabetes (T2D) populations, with relatively limited data specific to T1D. This creates uncertainty around how guidelines should be applied and may contribute to variability in clinical practice.
Available evidence suggests that uptake of these therapies in T1D is low, particularly for lipid-lowering therapies. However, there is limited understanding of why these gaps exist. Prior studies have identified potential barriers such as patient preference for lifestyle interventions, prioritization of glycemic control over cardiovascular risk management, and provider-level constraints including limited time and concerns about adverse effects. However, these insights are often based on small or non-T1D-specific populations.
There is therefore a critical need for a more comprehensive and T1D-specific understanding of both treatment patterns and the underlying drivers of underutilization. By combining large-scale real-world data analysis with qualitative and quantitative research among patients and providers, this study will provide a more complete picture of where gaps occur and why.
This evidence will be essential to inform targeted interventions and strategies aimed at improving the use of effective CVD prevention therapies in people with T1D/
Description of Project
People living with type 1 diabetes (T1D) face a significantly higher risk of cardiovascular disease (CVD), often developing complications earlier and experiencing worse outcomes than the general population. Although clinical guidelines recommend the use of lipid-lowering therapies, antihypertensives, and antiplatelet agents to reduce this risk, real-world use of these therapies in T1D remains suboptimal.
One key challenge is that most evidence guiding CVD prevention comes from studies in type 2 diabetes (T2D), with limited data specific to T1D. There is an incomplete understanding of how these therapies are used in T1D populations and why eligible patients may not receive them. Both patient- and provider-level factors may contribute, including differences in risk perception, competing priorities such as glycemic control, and practical barriers such as time constraints or concerns about side effects.
This study aims to address these gaps by combining large-scale data analysis with direct input from patients and healthcare providers. First, we will analyze real-world claims data to quantify how often CVD prevention therapies are used in people with T1D and identify where gaps exist. Second, we will conduct interviews and surveys with physicians and patients to understand the reasons behind these gaps, including barriers to prescribing and therapy use.
The results will be used to develop practical, evidence-based strategies to improve the uptake of CVD prevention therapies in T1D. These may include educational initiatives, clinical decision support tools, and patient-focused interventions. Findings will also be disseminated through peer-reviewed publications to raise awareness and inform broader clinical and policy efforts.
By improving understanding of current treatment patterns and the factors driving underutilization, this research aims to support more effective prevention of cardiovascular disease and ultimately improve outcomes for people living with T1D.
Anticipated Outcome
General Audience Summary - Anticipated Outcome
This study is expected to generate a robust, evidence-based understanding of how cardiovascular disease (CVD) prevention therapies are currently used in people with type 1 diabetes (T1D), as well as the key factors influencing their use.
Key anticipated outcomes include:
• A detailed characterization of real-world treatment patterns for lipid-lowering therapies, antihypertensives, and antiplatelet agents in T1D
• Identification of gaps in therapy use across different patient segments, including those eligible for primary and secondary prevention
• Insights into the clinical, behavioral, and system-level drivers and barriers influencing prescribing and therapy use
• A clearer understanding of patient perspectives, including awareness of CVD risk and attitudes toward preventive treatment
These findings will be translated into actionable recommendations for improving uptake of CVD prevention therapies. Potential outputs may include strategies such as enhanced provider education, clinical decision support tools, patient awareness initiatives, and policy or advocacy efforts.
In addition, the study will produce peer-reviewed publications that highlight the identified gaps and their underlying drivers. These publications will contribute to broader awareness within the medical and scientific community and support efforts to improve guideline implementation and patient outcomes.
Overall, the study will provide a strong foundation for targeted interventions aimed at reducing cardiovascular risk and improving long-term outcomes for people living with T1D.
Relevance to T1D
This study is highly relevant to type 1 diabetes (T1D) because it addresses a major and under-recognized contributor to morbidity and mortality in this population: cardiovascular disease (CVD).
While advances in glucose management have improved outcomes for people with T1D, cardiovascular complications remain a leading cause of death. Despite this, prevention of CVD has historically received less focus in T1D compared to glycemic control. In addition, much of the evidence guiding CVD prevention strategies is derived from type 2 diabetes (T2D), limiting its applicability to T1D populations.
As a result, there are significant gaps in both knowledge and practice. Many people with T1D who could benefit from preventive therapies are not receiving them, and the reasons for this are not well understood. These gaps represent an important opportunity to improve outcomes through better use of existing therapies.
This study directly addresses these challenges by focusing specifically on T1D populations. By quantifying treatment patterns and identifying barriers from both patient and provider perspectives, it will generate T1D-specific insights that are currently lacking.
The findings will support the development of targeted strategies to improve uptake of CVD prevention therapies in T1D, ultimately contributing to reduced cardiovascular risk and improved long-term health outcomes for this population.