Tolpin, Eddie (2025) One Size Doesn't Fit All: An Analysis of Cardiovascular Risk Modeling to Guide Shared Decision-Making in Type 1 Diabetes. thesis, Medicine.
Full text available on request.Abstract
Background Type 1 diabetes mellitus (T1D) is an autoimmune condition characterized by insulin deficiency and an increased risk of cardiovascular disease (CVD). Guidelines suggest preventive strategies in line with type 2 diabetes recommendations, but potential individual treatment benefits in CVD remain unknown. The Life-T1D competing risk-adjusted lifetime risk model provides personalized 10-year and lifetime CVD-risk estimates in T1D. Combining lifetime risk calculations with potential benefit from lipid and blood pressure lowering may be used to calculate individual benefit from these treatments. Design This single-center observational study accrued patients with T1D without macrovascular disease. Clinical data were collected and analyzed with the Life-T1D model. The primary outcome observed CVD-free life years gained based on guideline-directed systolic blood pressure and LDL-cholesterol treatment goals. To show the impact of lifetime risk, the outcomes were presented in quartiles of risk. Secondary outcomes included 10-year and lifetime CVD-risk in patients <40 versus patients ≥40. Results 313 patients with T1D (mean age 52 years, mean age at diagnosis 20 years) were included. All risk quartiles benefited from optimal CVD-management. The greatest gains were in the quartile with the highest CVD-risk (+1.2 CVD-free years). Most patients (98%) <40 years had low (<5%) 10-year CVD-risk scores, but higher lifetime risk than the ≥40 population. Lastly, statins in all risk quartiles were underprescribed, even for groups with a clear statin indication. Conclusion Individual CVD-risk factor characterization in T1D can identify undertreated CVD-risk factors, facilitate shared decision-making and improve adherence to long-term treatment plans.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Westerink, Dr. Jan and Dijk, Dr. Peter van |
| Faculty: | Medical Sciences |
| Date Deposited: | 12 May 2026 12:37 |
| Last Modified: | 12 May 2026 12:37 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3951 |
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