OBJECTIVE -To determine the extent to which patients' awareness, treatment, and control of hypertension and hypercholesterolemia have changed over time and to examine factors associated with awareness and treatment in a type 1 diabetes population.RESEARCH DESIGN AND METHODS -Data from six examinations conducted over 10 years from the Pittsburgh Epidemiology of Diabetes Complications Study, a prospective study of subjects with childhood-onset (Ͻ17 years of age) type 1 diabetes diagnosed between 1950 and 1980 and followed since 1986, were analyzed. Hypertension and hypercholesterolemia were defined according to the concurrent Joint National Committee and National Cholesterol Education Program Adult Treatment Panel criteria, respectively. RESULTS -Results demonstrated that awareness of both conditions has improved; however, control is not optimal (e.g., only 32.1 and 28% of those with hypertension in 1986 -1988 and 1996 -1998 were controlled, while for hypercholesterolemia, the rates were 0 and 5.5%, respectively). Stratified by age-group (18 -29, 30 -39, and Ͼ40 years), the youngest subjects with hypercholesterolemia were least likely to be treated and controlled to goal levels. Older age and physician contact were correlates of awareness and treatment of hypertension at baseline, while presence of renal or coronary complications was also associated with awareness and treatment of both hypertension and hypercholesterolemia at the 10-year follow-up.CONCLUSIONS -There is a considerable treatment gap, particularly for hypercholesterolemia. Improved treatment of both hypertension and hypercholesterolemia are clearly needed, particularly hypercholesterolemia in younger age-groups who have not yet experienced longterm complications. Diabetes Care 28:521-526, 2005H ypertension and hypercholesterolemia are important risk factors for the development of micro-and macrovascular complications in people with diabetes. Studies examining cardiovascular events among people with type 2 diabetes demonstrate that controlling these risk factors can directly impact the occurrence of both new (1) and repeat (2) events. Additionally, data suggest that people with type 1 diabetes and renal disease may experience remission or regression of their renal disease with aggressive antihypertensive treatment (3).While primary and secondary prevention of complications should be paramount, reports of suboptimal levels of treatment and control of these risk factors are abundant in the literature. The proportion of hypertensive individuals treated and controlled in the general population range from 10 to 41% (4,5), while for people with diabetes, rates range from 11 to 23% (6 -9). For hypercholesterolemia, reports indicate that 18 -37% of those treated and at high risk for an event in the general population are controlled (10), while 16 -35% of those with diabetes are controlled (8,9). Reasons for inadequate control are often centered on lack of access to health care, yet 90% of people with diabetes have access to a health care provider and have h...

These data suggest that there may be cultural and/or gender differences in the experience of symptoms of anxiety and depression, and also differences in the relationship between psychological symptomatology and diabetes self-care. Our findings have implications for the understanding of the role psychosocial factors play in the management of diabetes.

Our project successfully demonstrated that the retinal screening software and workflow process can be used to overcome challenges of providing adequate screening and diagnostic services for people at risk for diabetic retinopathy.