The Conundrum of Type 1 Diabetes: Part 2

Case Study

Part A:

Mr. Allen is a 40 year old man who has lived with type 1 diabetes for 18 years. He has developed diabetic retinopathy and microalbuminuria.

What is the best approach for vascular protection for Mr. Allen?

Reveal Answer

Due to his end organ damage with microvascular disease (retinopathy, microalbuminuria), the 2013 CDA guidelines recommend therapy with:

  • Statin to target LDL ≤2.0 mmol/L
  • ACE inhibitor or ARB in doses that have been shown to have vascular protection

Part B:

Ms. Staten is a 40 year old woman who has lived with type 1 diabetes for 18 years. Ms. Staten has developed diabetic retinopathy and microalbuminuria.

What is the best approach for vascular protection for Ms. Staten?

Reveal Answer

Due to her end organ damage with microvascular disease (retinopathy, microalbuminuria), the 2013 CDA guidelines recommend therapy* with:

  • Statin to target LDL ≤2.0 mmol/L
  • ACE inhibitor or ARB in doses that have been shown to have vascular protection

 

*The above vascular protective medications have the potential to cause embryopathy:

  • ACEi / ARBs in the 2nd trimester and beyond (controversial effects in the 1st trimester)
  • Statins throughout pregnancy

Therefore, these vascular protective medications should only be used in the presence of proper preconception counseling and reliable contraception in women of childbearing age. A woman’s pregnancy plans should be discussed at every visit.

  • Statins should be stopped prior to conception
  • ACEi or ARBs should be stopped either prior to conception or immediately upon detection of pregnancy

*The Canadian Diabetes Association is the registered owner of the name Diabetes Canada. All content on guidelines.diabetes.ca, CPG Apps and in our online store remains exactly the same. For questions, contact communication@diabetes.ca.